{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T19:33:28Z","timestamp":1767987208326,"version":"3.49.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T00:00:00Z","timestamp":1621123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011033","name":"Thermo Fisher Scientific","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011033","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective and design<\/jats:title>\n                  <jats:p>We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects and methods<\/jats:title>\n                  <jats:p>We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (&amp;lt;75\u00a0years [n\u2009=\u20097,079], 75\u201380\u00a0years [n\u2009=\u20091,034], 81\u201385\u00a0years [n\u2009=\u2009803] and\u2009&amp;gt;85\u00a0years [n\u2009=\u2009505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of \u22121.99 (95% confidence interval [CI] \u22122.36 to \u22121.62), \u22121.98 (95% CI \u22122.94 to \u22121.02), \u22122.20 (95% CI \u22123.15 to \u22121.25) and\u2009\u2212\u20092.10 (95% CI \u22123.29 to \u22120.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction &amp;gt;0.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afab078","type":"journal-article","created":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T11:10:13Z","timestamp":1619262613000},"page":"1546-1556","source":"Crossref","is-referenced-by-count":8,"title":["Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials"],"prefix":"10.1093","volume":"50","author":[{"given":"Eva","family":"Heilmann","sequence":"first","affiliation":[{"name":"Medical University Department, Kantonsspital Aarau, Aarau, Switzerland"},{"name":"Departement of Oncology, Kantonsspital Aarau, Aarau, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Gregoriano","sequence":"additional","affiliation":[{"name":"Medical University Department, Kantonsspital Aarau, Aarau, Switzerland"},{"name":"Departement of Oncology, Kantonsspital Aarau, Aarau, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Djillali","family":"Annane","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Hyperbaric Medicine and Home Respiratory Unit, Center for Neuromuscular Diseases, Raymond Poincar\u00e9 Hospital (AP-HP), Garches, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konrad","family":"Reinhart","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany"},{"name":"Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lila","family":"Bouadma","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), Univeersit\u00e9 Paris 7-Denis-Diderot, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Wolff","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), Univeersit\u00e9 Paris 7-Denis-Diderot, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Chastre","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), Univeersit\u00e9 Paris 7-Denis-Diderot, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles-Edouard","family":"Luyt","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Assistance Publique-H\u00f4pitaux de Paris (AP-HP), Sorbonne Universit\u00e9, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florence","family":"Tubach","sequence":"additional","affiliation":[{"name":"D\u00e9partement d\u2019Epid\u00e9miologie Biostatistique et Recherche Clinique, AP-HP, H\u00f4pitaux Universitaires Paris Nord Val de Seine, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela R","family":"Branche","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rochester General Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Briel","sequence":"additional","affiliation":[{"name":"Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam","family":"Christ-Crain","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Welte","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caspar","family":"Corti","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Hospital Bispebjerg, Copenhagen University, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evelien","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, VU University Medical Center, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maarten","family":"Nijsten","sequence":"additional","affiliation":[{"name":"University Medical Centre, University of Groningen, Groningen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dylan W","family":"de Lange","sequence":"additional","affiliation":[{"name":"University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos A H","family":"van Oers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albertus","family":"Beishuizen","sequence":"additional","affiliation":[{"name":"Medisch Spectrum Twente, Enschede, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armand R J","family":"Girbes","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, VU University Medical Center, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo O","family":"Deliberato","sequence":"additional","affiliation":[{"name":"Critical Care Unit, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Dueren, Dueren, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina B","family":"Kristoffersen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie","family":"Layios","sequence":"additional","affiliation":[{"name":"Department of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Li\u00e8ge, Liege, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Damas","sequence":"additional","affiliation":[{"name":"Department of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Li\u00e8ge, Liege, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella S S","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vandack","family":"Nobre","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Long","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Medicine, Shanghai Fifth People\u2019s Hospital, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina F","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yahya","family":"Shehabi","sequence":"additional","affiliation":[{"name":"Critical Care and Peri-operative Medicine, Monash Health, Melbourne, Australia"},{"name":"Faculty of 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