Procalcitonin-guided early cessation of antibiotics prevents gut inflammation and preserves gut microbiome: Data from the PROGRESS controlled trial.

Summary

Building on the PROGRESS RCT, PCT-guided early cessation of antibiotics preserved gut microbiome composition and reduced intestinal inflammation (lower fecal calprotectin) compared with standard durations. These findings mechanistically support the survival and AMR benefits previously observed with PCT-guided stewardship.

Key Findings

• PCT-guided early discontinuation reduced MDR/C. difficile infections and was associated with survival benefit in the parent trial.
• Microbiome profiling (16S rRNA Nanopore) showed better preservation of gut community structure with PCT-guided stopping versus standard durations.
• Fecal calprotectin levels indicated reduced intestinal inflammation with PCT-guided early cessation.

Clinical Implications

Supports using PCT to individualize and shorten antibiotic courses in sepsis of common sources, balancing efficacy with microbiome protection and reduced MDR/C. difficile risk.

Limitations

• Abstract-provided results are directional without granular effect sizes; full quantitative data not available here
• 16S sequencing limits strain-level resolution; trial not primarily blinded for antibiotic duration

Future Directions

Integrate metagenomics/metabolomics to refine microbial and functional shifts, and test PCT-guided stewardship across diverse settings with patient-centered outcomes and AMR endpoints.