James A. Newton
Physician compliance with procalcitonin-guided antimicrobial stewardship recommendations was associated with a reduction in length of antimicrobial therapy at a community hospital in Arkansas, researchers reported in Open Forum Infectious Diseases.
“Procalcitonin (PCT) is a quick and inexpensive test that can provide helpful information for an antibiotic stewardship program (ASP),” James A. Newton, MD, FACP, FIDSA, medical director of the antibiotic stewardship program at Washington Regional Medical Center in Fayetteville, Arkansas, told Infectious Disease News. “It provides evidence-based guidance for early antibiotic discontinuation and shorter duration of therapy. Our study shows that PCT guidance can have a positive impact on an ASP in the community hospital setting, where staffing shortages and resource limitations can be a challenge.”
Newton and colleagues retrospectively analyzed 857 adult patients with at least one PCT value and concomitant ASP recommendations between May 2013 to April 2014. Physicians complied with 73.7% of the ASP recommendations, and based on compliance, the researchers did not observe significant differences in length of stay (LOS).
In the ASP-compliant group, mean length of therapy (LOT) after recommendations and mean total LOT were significantly shorter. Specifically, mean LOT after recommendations in the compliant group was 2.5 days compared with 3.9 days in the noncompliant group (P < .0001), and mean total LOT was 5.1 days in the compliant group compared with 6.6 days (P < .0001).
The researchers also stratified by initial PCT levels and found that patients in the compliant group with normal PCT levels had the shortest LOT compared with all other groups. Additionally, patients with elevated PCT levels in the compliant group experienced significantly shorter LOT at 5.79 days compared with those in the non-compliant group, whose LOT was 7.12 days (P < .0111). According to the study, LOS was marginally shorter among patients in the compliant group when researchers controlled for baseline differences in initial PCT levels.
“Antibiotic duration can be safely shortened with PCT guidance from an ASP, which may lead to fewer adverse events and may decrease the development of antimicrobial resistance,” Newton said.
A previous study demonstrated that an algorithm guided by PCT could safely reduce the duration of antibiotic therapy. Another showed that, among patients with acute respiratory infections, treatment guided by PCT reduced the risk for mortality. However, researchers who investigated the use of PCT levels to distinguish bacterial from viral community-acquired pneumonia found that serum PCT levels are not sufficiently sensitive or specific enough. And findings from the ProACT trial suggested that PCT-based guidance in the ED does not have a significant impact on antibiotic use among patients with suspected lower respiratory tract infections.
“Further research is needed to determine whether PCT guidance can affect patient safety outcomes, such as recurrence rates of the same infection and readmission rates. Further study to compare outcomes in patients who received ASP advice with and without the benefit of PCT guidance is also warranted,” Newton said. “It would be helpful to stratify patients with specific presenting symptoms or specific diagnoses to determine if you can safely use shorter antibiotic courses with PCT guidance in an ASP program.” – by Marley Ghizzone
Disclosures: Newton reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.