{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:33:09Z","timestamp":1776706389554,"version":"3.51.2"},"reference-count":49,"publisher":"Walter de Gruyter GmbH","issue":"2","license":[{"start":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T00:00:00Z","timestamp":1601251200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"crossref","award":["KSA 2019 001"],"award-info":[{"award-number":["KSA 2019 001"]}],"id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2020-0931_abs_001_w2aab3b7d100b1b6b1aab1c15b1Aa\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-0931_abs_002_w2aab3b7d100b1b6b1aab1c15b2Aa\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>) in three groups (GFR &gt;90 [chronic kidney disease; CKD 1], GFR 15\u201389 [CKD 2\u20134] and GFR&lt;15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-0931_abs_003_w2aab3b7d100b1b6b1aab1c15b3Aa\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to\u00a0control patients (n=2,510) (9.5\u20137.6\u00a0days; adjusted difference in days\u00a0\u22122.01 [95% CI,\u00a0\u22122.45 to\u00a0\u22121.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6\u00a0days [95% CI\u00a0\u22123.59 to\u00a0\u22121.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p\u00a0interaction &gt;0.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-0931_abs_004_w2aab3b7d100b1b6b1aab1c15b4Aa\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2020-0931","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T12:29:41Z","timestamp":1601296181000},"page":"441-453","source":"Crossref","is-referenced-by-count":13,"title":["Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a\u00a0patient-level meta-analysis from randomized controlled trials"],"prefix":"10.1515","volume":"59","author":[{"given":"Eva","family":"Heilmann","sequence":"first","affiliation":[{"name":"Medical University Department , Kantonsspital Aarau , Aarau , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Gregoriano","sequence":"additional","affiliation":[{"name":"Medical University Department , Kantonsspital Aarau , Aarau , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannick","family":"Wirz","sequence":"additional","affiliation":[{"name":"Medical University Department , Kantonsspital Aarau , Aarau , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles-Edouard","family":"Luyt","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Sorbonne Universit\u00e9, Assistance Publique-H\u00f4pitaux de Paris (AP-HP) , Paris , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Wolff","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale, Universit\u00e9 Paris 7-Denis-Diderot, Assistance Publique-H\u00f4pitaux de Paris (AP-HP) , Paris , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Chastre","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale, Universit\u00e9 Paris 7-Denis-Diderot, Assistance Publique-H\u00f4pitaux de Paris (AP-HP) , 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":"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":"Lila","family":"Bouadma","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale, Universit\u00e9 Paris 7-Denis-Diderot, Assistance Publique-H\u00f4pitaux de Paris (AP-HP) , Paris , France"}],"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":"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":"Kristina B.","family":"Kristoffersen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases , Aarhus University Hospital , Aarhus N , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina F.","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine , School of Medcine, Federal University of Minas Gerais , Belo Horizonte , Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiana","family":"Stolz","sequence":"additional","affiliation":[{"name":"Clinic of Pneumology and Pulmonary Cell Research , University Hospital Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Tamm","sequence":"additional","affiliation":[{"name":"Clinic of Pneumology and Pulmonary Cell Research , University Hospital Basel , Basel , Switzerland"}],"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":"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":"Yahya","family":"Shehabi","sequence":"additional","affiliation":[{"name":"Critical Care and Peri\u2010operative Medicine , Monash Health , Melbourne , Australia"},{"name":"School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University , Melbourne , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Verduri","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences , Policlinico di Modena, University of Modena and Reggio Emilia , Modena , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vandack","family":"Nobre","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine , School of Medicine, Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais , Brazil"}],"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":"deLange","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":"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":"Beat","family":"Mueller","sequence":"additional","affiliation":[{"name":"Medical University Department , Kantonsspital Aarau , Aarau , Switzerland"},{"name":"Faculty of Medicine, University of Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Schuetz","sequence":"additional","affiliation":[{"name":"Medical University Department , Kantonsspital Aarau , Aarau , Switzerland"},{"name":"Faculty of Medicine, University of Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2020,9,28]]},"reference":[{"key":"2023033111461502296_j_cclm-2020-0931_ref_001_w2aab3b7d100b1b6b1ab2b2b1Aa","doi-asserted-by":"crossref","unstructured":"NICE antimicrobial stewardship: right drug, dose, and time?. 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