{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T22:38:57Z","timestamp":1792535937984,"version":"4.5.0"},"reference-count":13,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["15\/99\/02"],"award-info":[{"award-number":["15\/99\/02"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"abstract":"Summary<\/jats:title>\n \n Introduction<\/jats:title>\n Biomarker\u2010guided antibiotic protocols using daily procalcitonin or C\u2010reactive protein have been proposed to optimise antibiotic duration in sepsis. This pre\u2010planned process evaluation of the ADAPT\u2010Sepsis trial examined delivery and clinician adherence to procalcitonin\u2010 and C\u2010reactive protein\u2010guided protocols.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An embedded descriptive process evaluation was conducted within the multicentre ADAPT\u2010Sepsis trial including 2760 adults across 41 UK critical care units. Patients were assigned to procalcitonin\u2010guided, C\u2010reactive protein\u2010guided or standard care. Algorithm\u2010generated recommendations (strong stop, suggest stop or standard care) were relayed to research staff and clinicians who remained blinded to group allocation. Adherence was defined as stopping biomarker sampling after advice. Advice timings, frequencies, adherence rates and reasons for non\u2010adherence were recorded and analysed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 2760 patients, strong stop advice occurred earlier in those allocated to the procalcitonin\u2010guided group compared with the C\u2010reactive protein\u2010guided group (mean difference \u20101.7\u2009days, 95%CI \u20102.5 to \u20100.9, p\u2009<\u20090.001). C\u2010reactive protein guidance generated a higher proportion of standard care advice (mean difference \u20109.1%, 95%CI \u201010.9% to \u20107.3%, p\u2009<\u20090.001). Overall advice adherence was greater in patients allocated to the C\u2010reactive protein group than those allocated to the procalcitonin group (mean difference \u20106.8%, 95%CI \u20109.0 to \u20104.5, p\u2009<\u20090.001), driven by the higher proportion of standard care advice and later stronger stop advice with higher adherence (mean difference \u201014.3%, 95%CI \u201021.8 to \u20106.8, p\u2009<\u20090.001). Reasons for advice non\u2010adherence included fixed\u2010duration microbiology guidance, illness severity, continuing fever and elevation of routine inflammatory markers, which did not differ between groups.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n A C\u2010reactive protein\u2010guided discontinuation protocol achieved higher clinician adherence, probably because its recommendations aligned more closely with established prescribing norms. In contrast, procalcitonin guidance produced earlier and more frequent stop signals, offering greater potential to reduce antibiotic exposure but requiring clinicians to accept earlier discontinuation than usual practice.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/anae.70439","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T22:01:21Z","timestamp":1792533681000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delivery and adherence of biomarker\u2010guided antibiotic treatment protocols in the\n ADAPT<\/scp>\n \u2010Sepsis clinical trial: an in\u2010trial descriptive process evaluation of daily procalcitonin\u2010 and C\u2010reactive protein\u2010guided protocols"],"prefix":"10.1111","author":[{"given":"Ranjit","family":"Lall","sequence":"first","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anower","family":"Hossain","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Poole","sequence":"additional","affiliation":[{"name":"Centre for Healthcare Evaluation, Device Assessment and Research Cardiff and Vale University Health Board Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Lloydwin","sequence":"additional","affiliation":[{"name":"Centre for Healthcare Evaluation, Device Assessment and Research Cardiff and Vale University Health Board Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harley","family":"Anderson","sequence":"additional","affiliation":[{"name":"Centre for Healthcare Evaluation, Device Assessment and Research Cardiff and Vale University Health Board Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"White","sequence":"additional","affiliation":[{"name":"Centre for Healthcare Evaluation, Device Assessment and Research Cardiff and Vale University Health Board Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-0164","authenticated-orcid":false,"given":"Paul","family":"Dark","sequence":"additional","affiliation":[{"name":"Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health The University of Manchester Manchester UK"},{"name":"Critical Care and Trauma Services Northern Care Alliance NHS Foundation Trust Greater Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the ADAPT\u2010Sepsis collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010026\u201008361\u20101"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.70109"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010018\u20102125\u20107"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.26458"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010025\u201005732\u2010w"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/17511437231169193"},{"key":"e_1_2_6_8_1","unstructured":"UK Health Security Agency.Start smart\u2014then focus: antimicrobial stewardship toolkit for English hospitals. Updated 12 September 2023.https:\/\/www.gov.uk\/government\/publications\/antimicrobial\u2010stewardship\u2010start\u2010smart\u2010then\u2010focus(Accessed August 26 2024)."},{"key":"e_1_2_6_9_1","unstructured":"Faculty of Intensive Care Medicine.Guidelines for the Provision of Intensive Care Services\u2014Version 2.1.2022.https:\/\/ics.ac.uk\/resource\/gpics\u2010v2\u20101.html(Accessed August 26 2024)."},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009\u20108981(02)00101\u20108"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7473.1013"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u20105908\u20107\u201037"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756\u2010025\u201001690\u20108"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2666\u20105247(24)00003\u2010X"}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.70439","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anae.70439","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.70439","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T22:01:22Z","timestamp":1792533682000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.70439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":13,"alternative-id":["10.1111\/anae.70439"],"URL":"https:\/\/doi.org\/10.1111\/anae.70439","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"anae.70439"}}