Clinicians have used
procalcitonin (PCT) (
biomarker to differentiate bacterial from non-bacterial
sepsis) to guide use of
antibiotics in patients. As the data for utility of PCT to discontinue
antibiotics in an antimicrobial stewardship program (ASP) are lacking, we aim to describe the outcomes of patients in whom PCT was used to discontinue
antibiotics under our ASP. An antimicrobial stewardship (AS) team intervened to discontinue
antibiotics in patients with persistent
fever or leucocytosis, source of
sepsis unknown or negative bacteriological cultures, who had completed an adequate course of
antibiotic therapy and had a PCT of <0.5 μg/L. Main outcomes evaluated were 14-day
re-infection, 30-day mortality and readmission.
Antibiotic therapy was discontinued in 42 patients in 1 year. Unknown source of
sepsis was found in 38% of the patients (including possible
malignant fever) and culture-negative
pneumonia was found in 21%. Two patients died of advanced
cancer. One patient decided for comfort care and died one week later. One patient died due to a second episode of
pneumonia 37 days after first PCT test. Six patients were readmitted within 30 days due to non-infectious causes. Three patients were readmitted due to culture-negative
pneumonia. None had a 14-day
re-infection. PCT used to discontinue
antibiotics under our ASP did not compromise patients' outcome.