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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)727-733
Number of pages7
JournalCurrent Medical Research and Opinion
Volume37
Issue number5
DOIs
StatePublished - 2021

Keywords

  • Procalcitonin
  • drug resistance
  • hospitals
  • infections
  • microbial
  • sepsis

ASJC Scopus subject areas

  • Medicine(all)

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