Procalcitonin to Guide 7 vs 14 Days of Antibiotics in Bloodstream Infections: A Secondary Analysis of the - Summary - MDSpire

Procalcitonin to Guide 7 vs 14 Days of Antibiotics in Bloodstream Infections: A Secondary Analysis of the

  • By

  • Rayoun Ramendra

  • Julie K. Wright

  • Kevin C. Kain

  • Bridget Kim

  • Hridesh Mishra

  • Kathleen Zhong

  • Pierre Aslanian

  • Alex Carignan

  • John Conly

  • Michael Detsky

  • Erick Duan

  • Gerald Evans

  • Jan O. Friedrich

  • Francois Lamontagne

  • Francois Lauzier

  • Derek R. Macfadden

  • John Marshall

  • Lauralyn McIntyre

  • John Muscedere

  • Andrew Morris

  • Ruxandra Pinto

  • Asgar Rishu

  • Henry T. Stelfox

  • Linda R. Taggart

  • Jennifer Tsang

  • Alexis F. Turgeon

  • Rob Fowler

  • Nick Daneman

  • June 29, 2026

  • 0 min

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Objective:

To investigate the association between serum procalcitonin (PCT) levels on day 7 of antibiotic treatment and 90-day mortality in patients with bloodstream infections (BSIs), and to assess differential mortality based on treatment duration.

Approach:
  • Study Design: Planned secondary analysis of the BALANCE trial, a multicenter, open-label, randomized clinical noninferiority trial comparing 7-day vs 14-day antibiotic courses for BSIs.
  • Participants: 125 participants from the BALANCE trial, with serum PCT levels measured at day 7.
  • Outcomes: Primary outcome was death from any cause within 90 days; secondary outcomes included ICU and hospital mortality, days alive and not admitted to ICU or hospital, and duration of mechanical ventilation.
  • Statistical Analysis: Utilized χ2 test for categorical variables and Mann-Whitney-U test for continuous variables; intention-to-treat approach for comparing treatment durations.
Key Findings:
  • 52% of participants had low serum PCT levels, while 48% had high levels. The median PCT level in the high group was 818 pg/mL. The study analyzed the risk difference in 90-day mortality between low and high PCT levels, with specific mortality rates reported.
Interpretation:

The study aimed to determine if PCT levels could guide antibiotic treatment duration and influence mortality outcomes in patients with BSIs.

Limitations:
  • Results were not reported to the clinical team during the trial.
  • Adherence to PCT-based recommendations was modest in previous studies.
Conclusion:

The analysis aimed to clarify the role of PCT levels in personalizing antibiotic treatment duration for BSIs.

Original Source(s)

Procalcitonin to Guide 7 vs 14 Days of Antibiotics in Bloodstream Infections: A Secondary Analysis of the

  • by Rayoun Ramendra, Julie K. Wright, Kevin C. Kain, Bridget Kim, Hridesh Mishra, Kathleen Zhong, Pierre Aslanian, Alex Carignan, John Conly, Michael Detsky, Erick Duan, Gerald Evans, Jan O. Friedrich, Francois Lamontagne, Francois Lauzier, Derek R. Macfadden, John Marshall, Lauralyn McIntyre, John Muscedere, Andrew Morris, Ruxandra Pinto, Asgar Rishu, Henry T. Stelfox, Linda R. Taggart, Jennifer Tsang, Alexis F. Turgeon, Rob Fowler, Nick Daneman

  • June 29, 2026

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