Impact of Procalcitonin Levels Combined with Active Intervention on Antimicrobial Stewardship in a Community Hospital

Abstract

BackgroundProcalcitonin (PCT) guidance alone or in conjunction with antibiotic stewardship programs (ASPs) has been shown to reduce antibiotic utilization and duration of therapy without adversely affecting patient outcomes.MethodsIn a community hospital, we investigated the impact of PCT with ASP recommendations on length of stay (LOS), length of antimicrobial therapy (LOT) after ASP recommendation, and total LOT over a 1-year period. Adult patients with at least 1 PCT value and concomitant ASP recommendations were included. Patients were grouped by provider ASP compliance and further stratified by normal versus elevated PCT values. No specific PCT algorithm was utilized.ResultsA total of 857 patients were retrospectively analyzed. Physicians complied with 73.7% of ASP recommendations. There were no significant differences in LOS based on ASP compliance. Mean LOT after ASP recommendations and mean total LOT were significantly shorter (2.5 vs 3.9 days, P < .0001 and 5.1 vs 6.6 days, P < .0001, respectively) in the ASP complier group. When stratified by initial PCT levels, ASP compliers for patients with normal PCT levels had the shortest duration of therapy for all groups; among patients with elevated PCT levels, the duration of therapy was significantly shorter in the ASP compliant group (5.79 vs 7.12 days, P < .0111). When controlling for baseline differences in initial PCT levels, LOS was found to be marginally shorter in the ASP compliant group (P = .076).ConclusionsProcalcitonin-guided ASP physician recommendations, when accepted by providers, led to reduction in LOT in a community hospital. This benefit was extended across patient groups irrespective of initial PCT levels.

Point prevalence surveys of antimicrobial use: a systematic review and the implications

“…Typically the first step to address concerns with inappropriate prescribing of antibiotics in hospitals is the documentation of current utilization and sensitivity patterns to help develop pertinent local guidelines, and subsequently monitor prescribing against these guidelines [117,121]. This can be part of instigating ASPs in hospitals to reduce inappropriate prescribing [129][130][131][132]. However, this is more challenging in lower-and middle-income countries (LMICs) in view of resource, manpower and cultural issues resulting in variable implementation to date [91][92][93]133].…”

“…Increasing AMR rates and irrational use of antibiotics can potentially be avoided through clinical pharmacist interventions as part of ASPs within hospitals [1135].Improving the rational use of antibiotics will also help decrease adverse drug reactions (ADRs) with antimicrobials currently the second most common reason for ADRs in the USA [136]. Prior use of antimicrobials is also a threat to the growth of multidrug-resistant microbes [109,137], and this must be carefully handled through multiple interventions in ambulatory care to reduce inappropriate prescribing and dispensing of antibiotics alongside ASPs within hospitals [129][130][131][132][133][138][139][140][141]. Comparing trends of antimicrobial prescribing between countries and policies also allows key stakeholder groups to understand the wide range of patterns of antimicrobial use and subsequent concomitant resistance between them to develop appropriate strategies to reduce AMR as part of National Action Plans [4,16,138-140,142,].…”

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

“…Several implementation trials have investigated the effect of PCT-guidance in antimicrobial stewardship programs [69][70][71][72][73][74][75][76][77]. Main conclusions of these trials include (i) reduction in antimicrobial consumption; (ii) reduction in length of stay; (iii) reduction in hospitalization cost; and (iv) no difference in infection-relapse of rehospitalization rate.…”

Implementation of Procalcitonin in Antibiotic Stewardship: Derivation of a Consensus Algorithm for Procalcitonin Use in Clinical Practice

“…Studies were mainly conducted on upper respiratory tract infections or respiratory infections, and the purpose was to reduce the duration of antibiotics use, especially in ICU patients with pneumonia, ventilator-associated pneumonia, and sepsis [ 29 ]. In the United States, the PCT test has not been used much before, but recently various studies are being conducted [ 28 37 ]. While CRP has been used for various purposes and studied for a long time, PCT has a shorter history since it was developed and studied than CRP, and PCT related studies have only been conducted on some infectious diseases, limiting the PCT test due to its difficulty to apply extensively in the clinical settings.…”