Decreased antibiotic exposure using a procalcitonin protocol for respiratory infections and sepsis in US community hospitals (ProCommunity).

Abstract

OBJECTIVE:

Antibiotic overuse leading to antimicrobial resistance is a global public health concern. Clinical trials have demonstrated that procalcitonin-based decision-making for antibiotic therapy can safely decrease inappropriate antibiotic use in patients with respiratory infections and sepsis, but real-world data are scarce. This study sought to assess the impact of a procalcitonin-based antibiotic stewardship program (protocol plus education) on antibiotic use in community hospitals.

METHODS:

An observational, retrospective, matched cohort study was conducted. Eligible patients treated in hospitals with a procalcitonin-based protocol plus education (Procalcitonin cohort hospitals) were matched to patients admitted to facilities without procalcitonin testing (Control cohort hospitals) using a 1:2 ratio. The Control hospitals were facilities where procalcitonin testing was not available on site. Patient matching was based on: (1) age, (2) gender, (3) admission diagnosis code using groupings of the International Classification of Diseases, 10th Revision, (4) whether patients were admitted to the intensive care unit, and (5) whether a blood culture test was performed. Procalcitonin cohort hospitals implemented a quality improvement initiative, where procalcitonin was available, used regularly, and clinicians (physicians and pharmacists) were educated on its use.

RESULTS:

After adjustment, patients in the Procalcitonin cohort had 1.47 fewer antibiotic days (9.1 vs. 8.5 days, 95%CI: -2.72; -0.22, p = .021). There was no difference in length of stay or adverse clinical outcomes except for increase in acute kidney injury (odds ratio = 1.26, 95%CI: 1.01; 1.58, p = .038).

CONCLUSIONS:

Patients with respiratory infections and sepsis in hospitals utilizing a procalcitonin-based protocol coupled with education received fewer days of antibiotic therapy.

• Authors: Kathryn E DeSear, Philippe Thompson-Leduc, Trevor C Van Schooneveld, Noam Kirson, Jacqueline J Chritton, Sue Ie, Hoi Ching Cheung, Susan Ou, Louise Zimmer, Philipp Schuetz
• Journal: Current medical research and opinion (Curr Med Res Opin) Vol. 37 Issue 5 Pg. 727-733 (05 2021) ISSN: 1473-4877 [Electronic] England
• PMID: 33617362 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Biomarkers
• Procalcitonin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Biomarkers
• Cohort Studies
• Hospitals, Community
• Humans
• Procalcitonin
• Respiratory Tract Infections (diagnosis, drug therapy)
• Retrospective Studies
• Sepsis (diagnosis, drug therapy)