Use of procalcitonin point-of-care testing to guide de-escalation of antibiotic therapy in adults with suspected bacterial sepsis in a tertiary hospital in Bangladesh: a randomised controlled open-label trial

Why clinicians should know about it

• Picked for Critical Care and Intensive Care Medicine (top studies of the week, 13 September 2026): Procalcitonin POC trial for antibiotic de‑escalation in sepsis
• Picked for Gastrointestinal and Colorectal Surgery (top studies of the week, 13 September 2026): Procalcitonin trial unrelated to GI surgical practice
• Picked for Pediatric Surgery (top studies of the week, 13 September 2026): Adult sepsis trial, no paediatric surgery relevance
• Picked for Microbiology (medical) (top studies of the week, 13 September 2026): Procalcitonin POC test to shorten antibiotic course

Abstract

BACKGROUND: Important drivers of antibiotic resistance in low- and middle-income countries (LMICs) include antibiotic overuse and scarcity of microbiological diagnostics. Procalcitonin point-of-care testing is a potential tool to guide antibiotic de-escalation in patients admitted with suspected bacterial sepsis. METHODS: In an open-label randomised controlled clinical trial in Chittagong Medical College Hospital in Bangladesh, adult patients with suspected bacterial sepsis were randomised to procalcitonin (PCT)-guided de-escalation of antibiotic therapy or standard-of-care. In the intervention group, serum procalcitonin was assessed daily and clinicians received a non-binding advice to stop antibiotics after 72 h if procalcitonin dropped below pre-defined threshold concentrations (0.5 ng/mL or 80% from the peak value if baseline value > 2 ng/mL). The primary endpoint was length of antibiotic therapy analysed by intention-to-treat. The study is registered with ClinicalTrials.gov (NCT05955612) and was completed in July 2024. FINDINGS: Between 26 July 2023 and 20 June 2024, 532 of the 1002 patients screened for eligibility were randomly assigned to procalcitonin-guided antibiotic therapy (n = 266) or standard-of-care (n = 266). Follow-up was completed on 30 July 2024. Median (interquartile range [IQR]) length of antibiotic therapy was 4.7 (2.8-8.0) days with procalcitonin-guided therapy compared to 9.0 (5.8-12.0) days in the control arm (p < 0.0001). Mortality was similar between the two groups. In the procalcitonin-guided arm, 23 of 265 participants died (8.7%; 95% confidence interval [CI], 5.6%-12.7%), compared with 21 of 265 participants (7.9%; 95% CI, 5.0%-11.9%) in the control arm. The absolute risk difference was 0.8 percentage points (95% CI, -3.9 to 5.5 percentage points) (p = 0.875). Following review, the Data Safety Monitoring Board did not identify any deaths as attributable to antibiotic discontinuation. The incidence of recurrent infections was 8/265 (3.0%) in procalcitonin-guided antibiotic therapy and 10/265 (3.8%) in the control arm (p = 0.811). INTERPRETATION: In this single-centre trial in Bangladesh, procalcitonin-guided de-escalation reduced the duration of antibiotic therapy in adults with suspected bacterial sepsis. Mortality and recurrent infection were similar between the groups, although the trial was not powered to assess these outcomes formally. This promising approach of point-of-care procalcitonin-guided antibiotic discontinuation should be evaluated further in comparable resource-limited settings. FUNDING: Wellcome Trust of Great Britain.

Abstract as published, via PubMed.