Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis

作者：Paul Dark, Md. Anower Hossain, Daniel F. McAuley, David Brealey, Gordon Carlson, Jonathan C. Clayton, Timothy Felton, Belinder Ghuman, Anthony Gordon, Thomas P Hellyer, Nazir Lone, Uzma Manazar, Gillian Richards, Iain McCullagh, Ronan McMullan, James J. McNamee, Hannah C. McNeil, Paul Mouncey, Micheal J. Naisbitt, Robert Parker, Ruth Louise Poole, Anthony Rostron, Mervyn Singer, Matt Stevenson, Timothy Walsh, Ingeborg Welters, Tony Whitehouse, Simon Whiteley, Peter Wilson, Keith A. Young, Gavin D. Perkins, Ranjit Lall, ADAPT-Sepsis Collaborators, Julian Bion, Alasdair MacGowan, Paul McCrone, Maurice O’Kane, Ben Attwood, Gordon Sturmey, Janet Prentice, Ly‐Mee Yu, Tom Clutton-Brock, Duncan Young, John Simpspm, Kay Marshall, Simon Gates, Judith White, Dipesh Mistry, Scott Regan, Noicola McGowan, Dalbir Kaur, Chen Ji, Nessa Nevels, Ingeborg Welters, Karen Williams, David Shaw, Victoria Waugh, Julie Patrick-Heselton, C. Paisley, Suzannah Phillips, Emily Johnson, Jaime Fernandez Roman, Maria Lopez Martinez, Arra Mahiya, Daniel Watkin, Zachary M. Thomas, Andrew Davison, Sofia Farina, Maria Norris, Silvia Manes, Jin-Xi Yuan, Josh Colfar, Caitlin Lythgoe, Ibrahim Almafreji, Lisa Bailey, Robert Parker, Ian Turner-Bone, Laura Wilding, Michaela Lloyd, Harriet Murrant, Leanne Smith, Ben Morton, Dylan Middleton, William D. McCaig, Amie Hughes, Lucy Fuller, Dominic Kay, Sharon Barber, Jane Parez, Stephanie J. Lee, Reece Doonan, Lisa Swindells, Jessica Pendlebury, Jessica Holden, Jacob Hadfeild, Jay Naisbitt, Andrew Caxton, Emma Parkin, Daniel Horner, Anila sukumaian, Benedict Gyamerah, Alice Dunombe, DR Chris Taylor, DR Wadhi Habeichi, Joanna Borzomato, Paul Ferris, Justin Roberts, James Nesbitt, Jonathan B. Clayton, John A. Macdonald, Alistair Roy, Anthony Rostron, Lindsey Woods, Sarah Cornell, Kimberley Rogerson, J Boxall, Trina Burns, Susan Cooper, Kirstie Knight, Sarah Constable, Laura Kenny, Jonathan Vernazza, Maxwell J. Richardson, Matthew Bickerton, Andrew Camplejohn, Roseanne Cope, Julie Sheriff, Helena Baker, Jessica Watson, Jodie Sedgwick, Simon Whiteley, Max Ridley, Richard Gould, Sarah Perrin, Elizabeth Wilby, Susan Trott, Sheila Salada, Sarah Watts, Zoe Friar, Bethan Ogg, Clare Howcroft, Kate Long, Alistair Morris, Julia Sampson, Alexandra Gibbins, C. Peters, Megan Meredith, Alice Baddeley, Anthony Baidoo, Daniel Harvey, Alexandra McCoy, Sophie Lubbock, David A. Ford, Amy Clark, Laura V. Lloyd, Mohammed Habib, Gemma Clark, Ian King, Carla Goode, Angela Sellick, Shova Sharma, Anita Assi, Jennifer Dengate, Matthew Grice, Laura Brammer, Chinyere Ajonu, Samuel Redgate, Wendy Smith, Manjinder Khakh, Hannah C. Howson‐Wells, Simon Atkin, Max Casbon, Frances Olsen, Bhavin Mistry, Victoria Mitchinson, Aysha Talbot, Iain McCullagh, Arti Gulati, Benjamin Brown, Stephanie Grieveson, Tara Lal Shrestha, Ian C. Storey, Fatima Simoes, Verity Calder, Carole Hays, Maite Babio-Galan, Deborah White, Jennifer Collins, Leigh Dunn, Susan Taylor, Luzgie Gavina, Tessa Wilkinson, Pamela Garcia, Lauren Butler, James Savage, Jayne Harwood, Sarah Cook, Stephen S. Hamilton, Jonathan Shelton, I Clement', Samantha Burn, Nathan Carroll, Lauren Clark, Lauren Ferguson, Sam Foggett, A. Hague, Tracy Handley, C. Hewison, Samantha Kitchener, Laura Mceachan, Nicole Mcewen, Ryan Perry, Olivia Purdy, Amie Thomson, Stephanie Williams, Glykeria Pakou, Helder Filipe, Margaret McNeil, Sara Mingo, Catarina Veiga, Poh Choo Teoh, Amitaa Maharajh, Mark De Neef, CH Cole, Alex Ross, Mark Belsham, Shatha Abu-Hijleh, Saida Solkar, Oghenemega Okotete, Peter Alexander, Luke Ward, Joanne Rothwell, Sherly George, Hannah Currie, Katharine Sellers, Gavin D. Perkins, Jo Gresty, Ellie Reeves, Teresa Melody, Helen R. Taylor, Sara Bawa, Celinamma Maliaykal, William J. McIver, Mohamed Mooradun, Tay-yibah Mohamed, Heather Willis, Aidan Butler, Amy Hooper, Adam Boulton, Lucie Linhartová, Rachel Smith, Daniel E. Park, Anna Dennis, Joyce Yeung, Hozefa Ebrahim, Neil Crooks, Sarah Milton-White, Sarah Ballinger, Natalie Carling, Chloe Norman, Marie Thomas, Alexandra H. Nance, Emma Evans, Lesley Horton, Madhu Balasubramaniam, Rebecca Flanagan, Emma McKenna, Scott Latham, Danielle Hollick, P Chinari, Celia Chu, Katy Edwards, Rashmi Gupta, Carolyn A. Williams, Lindwe Mashangombe, M JAVED, Timothy Walsh, Maria Amamio, Gillian Andrew, Lucy Barclay, Sophie Birch, Kate Briton, Lisa-Marie Butt, Sarah L. Clark, J. Crossan, Katherine Doverman, Michael Gillies, David Griffith, David Hope, Kallirroi Kefala, Ian F. Laurenson, Nazir Lone, Lucy MacDonald, Craig Marshall, Corrienne McCulloch, Gregor McNeill, Nicola Rea, Scott A. Simpson, Jo Singleton, Elzbieta Czarniak, O. Nieto, Joanne Thompson, Ceri Lynch, Bethan Gibson, Piroska Toth-Tarsoly, Z Auer, D. C. Law, Jayparaska Singh, Shaun Oram, Arsalan Zaki, Alan Dodd, Bethan Deacon, L Roche, Leannne Jones, Justyna Smeaton, Kevin Agravante, Oladele Akinyoola, Keri Turner, Joanne Pugh, Sam Evans, Lisa Mellish, Angharad Rees, Geraint Lewis, John M. Burke, Nia Bromage, Nicola Llewellyn, Justine Evans, Marlo Constantino, Redmond Tully, Andrew Drummond, Joy Dearden, Michelle Mulcahy, Carrole Blessen, Angiy Vian-Michael, Grainne O'Connor, Jonathan Scargill, Sarah Winnard, James J. McNamee, Danny Mcauley, Peter McGuigan, Karen Ward, Justine Ward, Aisling O’Neill, Stephanie Finn, Erin Collins, Jackie Green, Christine B. Turley, Gérard Quinn, Matthew D. Adams, Chris Wright, Gareth McKeeman, Rory Loughlin, Lynsey Reilly, Heather Gallagher, Steve Coward, Rachel Morrison, Shondipon Laha, Sushruth Madanapalli Raghunath, Alex Jude Fonseca, Alexandra Williams, Sacha Connor, Rebecca Allock, Lisa Halsall, Sean McMullen, Jayanthi Rajasekar, Sarah Purvis, Isha Garg, Vijay Jagannathan, Hillie Corr, M. Stefaniak, Simon Sinclair, Chris Wilson, David Brealey, Niall MacCallum, Ingrid Hass, Georgia Bercades, Deborah Smyth, Gladys Martir, Anna Reyes, Maria Alexandra Zapata Martinez, Laura Gallagher, Hodan Omer, John A. Smith, Deborah Paripoorani, Charlotte Taylor, Gregory P. Yates, Katharine Wylie, Sadiya Salah, Fionn Quilty, Stephen Bonner, Jeremy Henning, Amy D. Thompson, Jessica Jones, Steven Liggett, Craig Mower, Sarah Bircham, Bobette Kamangu, Abiola Shoremekun, Anitha Ratnakumar, Keith Hugill, Tom Lawton, Amy Robinson, Rafaq Azad, M Kitching, Chris Cockcroft, Louise Akeroyd, Jackie Todd, Susan Kimachia, Lisa A. Burgess, Shereen Bano, Fiona Jutsum, Laura Price, Susie Pajak, Hannah Gibson, Mark C. Bates, Karen Reid, Alison Bland, Alison Stephens, Denise Donaldson, Mandy Beekes, Jo Stickley, Colene Adams, Amy Bowes, Sanal Jose, Nikolaos Manetas-Stavrakakis, Rebecca Wilcox, Rachel Rikunenko, Maria Houghton, Andrew J. Donnelly, Julie Summers, Christopher J Mowatt, Katherine Richmond, Rebecca Jones, Tammy Davie, Michael F. Barnsley, Mick Pursglove, James Pearce, Philippa Lane, Natasha Cole, Megan Phillips, J Jasiewicz, Samar Hamad, Jyoti Sharma, Muhammad Adeeb, Mohammad Qasim, Lisa Barnsley, Louise Walton, Claire Wright, Helen Kaura, Cathy McCormack, Dave Latham, E. Staten Wynne, C.V. McCormack, K. M. V. Richmond, Christopher Thompson, Minnie Gellamucho, Jane Delaney, Michelle Davies, Elisa Sernicola, Lucy Bailey, Angelene Cope, Claire Hudson, Umar Mohyddin, Jack Lee, Ben Storey-Waters, Faye Halliday, G. Mathew, Sarah Birch, Dumindu Karangoda, Estefania Treus, Leanne Howard, Georgina Luck, Claire Gabriel, Richard Lowsby, Elijah Matovu, Katherine Pagett, D Maren, Tenifayo Adeyemo, Hannah David, Mark Quiambao, Joanne Harold, Sheron Clarke, Valery Gurov, Anthony Mkandhla, Chris Duff, Helen Duce, Tony Whitehouse, Liz Ratcliffe, Anna Casey, Natalie Dooley, Karen Ellis, Christopher Sheridan, Lisa Moody, Puja Mulholland, Rachel M. Webster, Samantha Harkett, Sophia Beddows, Caroline Dooley, E. F. Mohamed Reda, Stephanie Goundry, Elaine Spruce, Tonny Veenith, Dhruv Parekh, Natalie Walmsley, Malikah Saba, Rebecca Gill, Esther Thomas, Jaimin Patel, Mansoor N. Bangash, Craig Denmade, Sarah E. White, Rosie Clare, Ya-Wen J Huang, Dawn Herbert, Lynn Rowbottom, Madeleine McGRADY, Matt Thomas, Paul Thomas, Ruth Worner, Borislava Borislavova, Kati Hayes, Beverley Faulkner, Emma Gendall, Elizabeth Goff, Hayley Blackmore, Mike Spivey, Sarah Bean, Karen Burt, Anthea Pattterson, Lisa Vipond, Matthew D. Martin, Nick Vallotton, Samuel Waterman, Michael Kelsey, Ana Alvaro, Loreta Mostoles, Anezka Pratley, Nabeel Amiruddin, H. T. Ashby, Gemma Wood, Gail Priestley, Phil Antil, J. W. S. Carter, David Yates, Rob Ferguson, H. Ballentine Carter, Zoe Cinquina · 发表于：JAMA · 年份：2024 · DOI：10.1001/jama.2024.26458 · 被引用次数：101 · 研究领域：Sepsis Diagnosis and Treatment、Neonatal and Maternal Infections、Bacterial Identification and Susceptibility Testing

Importance: For hospitalized critically ill adults with suspected sepsis, procalcitonin (PCT) and C-reactive protein (CRP) monitoring protocols can guide the duration of antibiotic therapy, but the evidence of the effect and safety of these protocols remains uncertain. Objective: To determine whether decisions based on assessment of CRP or PCT safely results in a reduction in the duration of antibiotic therapy. Design, Setting, and Participants: A multicenter, intervention-concealed randomized clinical trial, involving 2760 adults (≥18 years), in 41 UK National Health Service (NHS) intensive care units, requiring critical care within 24 hours of initiating intravenous antibiotics for suspected sepsis and likely to continue antibiotics for at least 72 hours. Intervention: From January 1, 2018, to June 5, 2024, 918 patients were assigned to the daily PCT-guided protocol, 924 to the daily CRP-guided protocol, and 918 assigned to standard care. Main Outcomes and Measures: The primary outcomes were total duration of antibiotics (effectiveness) and all-cause mortality (safety) to 28 days. Secondary outcomes included critical care unit data and hospital stay data. Ninety-day all-cause mortality was also collected. Results: Among the randomized patients (mean age 60.2 [SD, 15.4] years; 60.3% males), there was a significant reduction in antibiotic duration from randomization to 28 days for those in the daily PCT-guided protocol compared with standard care (mean duration, 10.7 [SD, 7.6...