Randomized Clinical Trial of Viral Testing and Serum Procalcitonin to Reduce Antibiotic Use for Respiratory Infections
Methods: After informed consent, patients hospitalized with LRTI were randomly assigned to a standard of care group (routine Flu & RSV PCR performed at provider’s discretion and no PCT) or an intervention group (Multiplex RT-PCR (FilmArray) and PCT obtained and released to providers with a PCT algorithm). Exclusions included ICU care, hypotension, >15% bands or a definite infiltrate on CXR. The primary outcome was comparison of antibiotic use in the two groups.
Results: From October 2013-April 2014, 300 illnesses were randomized. Patients in both arms were well matched for comorbidities and admitting diagnoses. Viruses were identified in 44% and 21%, p=.001 of intervention and nonintervention subjects, respectively. PCT was < 0.25 ug/ml (antibiotics not recommended per algorithm) in 86% of subjects in the intervention group. There were no significant differences in length of stay (LOS), total antibiotic days and discharge on antibiotic. Subjects with PCT > 0.25 ug/ml had significantly longer LOS and increased antibiotic use. Viral positive/low PCT subjects were less frequently discharged on antibiotics compared to nonintervention patients (18% vs. 38%, P=0.02) and had significantly less IV antibiotic use (p=0.008). Compared to the same patient population from a previous study (2008-2012), total antibiotic use decreased from 83% to 76% (p=0.02) suggesting a possible study effect. In a survey of physicians, 92% indicated that viral and PCT testing frequently or sometimes changed their management.
Conclusion: Despite being well accepted, the combination of viral and PCT testing did not result in overall reduced antibiotic use in the intervention group. However, modest reductions in antibiotic use in viral positive/low PCT subjects suggest this approach deserves further study.
Alios Biopharma: Consultant, Consulting fee
A. Falsey, Regeneron: Consultant, Consulting fee
Hologic: Consultant, Consulting fee
Sanofi Pasteur: Research Contractor, Research grant
AstraZeneca: Research Contractor, Research grant
ADMA Biologic Inc: Research Contractor, Research grant
R. L. Vargas, None
B. Hulbert, None