Procalcitonin in intensive care units: the PRORATA trial
2010; Elsevier BV; Volume: 375; Issue: 9726 Linguagem: Inglês
10.1016/s0140-6736(10)60695-2
ISSN1474-547X
AutoresWilliam Tarnow‐Mordi, Val Gebski,
Tópico(s)Intensive Care Unit Cognitive Disorders
ResumoWe believe that the PRORATA trial1Bouadma L Luyt CE Tubach F et al.Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial.Lancet. 2010; 375: 463-474Summary Full Text Full Text PDF PubMed Scopus (898) Google Scholar is of major concern, and potentially misleading, in suggesting that a strategy guided by procalcitonin could “reduce antibiotic exposure and selective pressure with no apparent adverse outcomes”. Lila Bouadma and colleagues assumed that a true excess mortality, or risk difference, in the procalcitonin group of up to 9·9% would not be inferior. This equates to a number needed to harm of ten. They conclude that the significant reduction (p<0·0001) of 2·7 days in mean exposure to antibiotics is worth a possible extra death for every ten patients treated by the procalcitonin strategy. If a true excess mortality as great as 2% (one extra death for every 50 patients treated with the procalcitonin strategy) were considered acceptable for a few days fewer antibiotics, this would require a non-inferiority trial with 16 500 patients. A true excess mortality of 4%, similar to that seen in the trial, would require about 4220 patients. The PRORATA trial, which recruited 621 patients, was grossly underpowered to provide reliable evidence for policy, but could be valuable in a synthesis of similar studies. Few patients would accept up to a 9·9% extra risk of death for 3 days fewer antibiotics. Why should your readers? We declare that we have no conflicts of interest. Procalcitonin in intensive care units: the PRORATA trial – Authors' replyDjamel Mokart and Marc Leone point out potential difficulties for interpreting procalcitonin concentrations in immunocompromised patients. In our trial, these patients had significantly lower antibiotic exposure in the procalcitonin group than in the control group (3·6 days), without significant differences in mortality and relapse rates. However, we agree that more trials are needed to confirm that a procalcitonin-guided strategy can reduce antibiotic use without adversely affecting outcomes in that specific subset of patients. Full-Text PDF
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