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Table 1 Characteristics of included studies

From: Procalcitonin-guided antibiotic therapy in intensive care unit patients: a systematic review and meta-analysis

Study/year Trial design Population Type of ICU N PCT/Ctrl PCT-guided group protocol Control group protocol PCT assay
Svoboda et al. [30] SC, P, R, OL Postoperative severe sepsis Surgical 38/34 AI: prompted change of ABT and catheter (≥ 2 ng/ml), prompted to repeated radiographic and/or surgical evaluation (< 2 ng/ml) Standard evaluation by consultant surgeon PCT-Q
Schroeder et al. [31] SC, P, R, OL Postoperative severe sepsis Surgical 14/13 AD: if clinic signs and symptoms improved and PCT < 1 ng/ml or 25–35% of baseline According to clinical signs and empiric rules LIA
Nobre et al. [32] SC, P, R, OL Sepsis Mixed 39/40 AD: if baseline PCT > 1 μg/L, re-evaluation at day 5. ABT discontinuation if PCT < 0.25 μg/L or PCT dropped by > 90% from the baseline peak level. If baseline PCT < 1 μg/L, re-evaluation at day 3. ABT discontinuation if PCT < 0.1 μg/L and careful clinical evaluation Regimens according to guidelines Kryptor
Hochreiter et al. [33] SC, P, R, OL Infection Surgical 53/57 AD: if clinic signs and symptoms improved and PCT < 1 ng/ml or 25–35% of initial value over 3 days Standard regimen over 8 days LIA
Stolz et al. [34] MC, P, R, OL Ventilator-associated pneumonia Mixed 51/50 AD: strongly encouraged (< 0.25 μg/L), encouraged (0.25–0.5 μg/L or a decrease ≥ 80%), discouraged (0.5–1.0 μg/L or a decrease < 80%) or strongly discouraged (> 1.0 μg/L) According to clinical signs and empiric rules Kryptor
Bouadma et al. [35] MC, P, R, OL Bacterial infection or sepsis Mixed 311/319 AI: ABT was strongly discouraged (< 0.25 μg/L), discouraged (0.25–0.49 μg/L), encouraged (0.5–0.99 μg/L) or strongly encouraged (≥ 1 μg/L)
AD: strongly encouraged (< 0.25 μg/L), encouraged (0.25–0.49 μg/L). continuing of ABT was encouraged (0.25–0.5 μg/L or > 80% peak) and change of ABT (> peak concentration and > 0.5 μg/L)
Regimens according to international and local guidelines Kryptor
Jensen et al. [13] MC, P, R, OL Severe sepsis/septic shock Mixed 212/247 AI: if PCT ≥ 1 μg/L that was not decreasing by at least 10% from previous day: increasing the antimicrobial spectrum and intensifying diagnostic efforts to find uncontrolled sources of infection According to current guidelines Kryptor
Layios et al. [36] SC, P, R, OL Infection Mixed 258/251 AI: ABT was strongly discouraged (< 0.25 μg/L), discouraged (0.25–0.5 μg/L), encouraged (0.5–1.0 μg/L) or strongly encouraged (> 1.0 μg/L) No reports Kryptor
Annane et al. [38] MC, P, R, OL Septic shock Mixed 31/31 AI/AD: ABT was not to be started or was to be discontinuation (< 0.25 μg/L); strongly discouraged (≥ 0.25 to < 0.5 μg/L); was recommended (≥ 0.5 to < 5 μg/L) and was strongly recommended (≥ 5 μg/L). For patients enrolled ≤ 48 h after surgery, the respective PCT cut-offs were < 4 μg/L, 4–9 μg/L and ≥ 9 μg/L ABT at the discretion of the patient’s physician Kryptor
Deliberato et al. [39] SC, P, R, OL Sepsis Mixed 42/39 AD: if PCT dropped > 90% from the peak level or the absolute value < 0.5 ng/ml The possible source of infection and local susceptibility profile Vidas
Shehabi et al. [23] MC, P, R, SB Bacterial infection or sepsis Mixed 200/200 AD: cease ABT when PCT < 0.1 ng/ml or PCT was 0.1–0.25 ng/ml and infection is highly unlikely or PCT level decreased > 90% from baseline According to the ABT guidelines Automated immunoassay analysers
De Jong et al. [24] MC, P, R, OL Infection Mixed 776/799 AD: if PCT value decreased over 80% or PCT value lower than 0.5 μg/L Guidelines and the discretion of attending physicians Vidas, Roche or Kryptor machine
Bloos et al. [37] MC, P, R, OL Severe sepsis/septic shock Mixed 587/593 AD: stopping ABT if PCT level on day 7 or later < 1 ng/ml r or dropped > 50% from the previous value According to the local sepsis guidelines Kryptor
  1. ABT antibiotics, AD antibiotic discontinuation, AI antibiotic initiation, Ctrl control, ICU intensive care unit, LIA immunoluminometric assay, MC multi-centre, Mixed surgical and medical intensive care unit, OL open label, P prospective, PCT procalcitonin, PCT-Q procalcitonin immunochromatographic technology, R RCT, SC single centre