Antibiotic Prescribing Adherence to Procalcitonin (PCT)-Generated Recommendations in Two Academic Medical Intensive Care Units (MICUs)
Background: Using serum PCT levels to help guide antibiotic duration in adult intensive care units reduced antibiotic use without adversely affecting survival or other outcomes in randomized controlled trials. We assessed the clinical utility of real-world PCT testing in two Chicago teaching hospital MICUs.
Methods: Concurrent PCT testing and teaching/guideline interventions deployed in reverse sequence in the two MICUs were approved as quality improvement projects by both hospital IRBs, with waiver of patient consent. Recipients of systemic antibacterials were targeted for daily PCT testing only while in the MICU; results appeared in patients' electronic records; MICU physicians (MDs) used published interpretive criteria to integrate PCT results with clinical data in making antibiotic prescribing decisions. We assessed MD prescribing decision/PCT level adherence over all PCT levels and for the last PCT measurement for each episode of care.
Results: PCT was measured 1240 times in 630 care episodes (median 2 tests/episode) for 540 patients over 10 months in MICU A. Over 5 months of ongoing testing in MICU B, PCT was measured 531 times during 131 episodes of care (median 3 tests/episode) for 121 patients. PCT results and patient-level trends generally mirrored infection severity and response to therapy. At hospital A, of 173 initially low PCT values, MDs stopped antibiotics 49 (28%) times; at hospital B, initial PCT values were not responded to. Adherence to PCT-generated recommendations for all PCT levels and for the last PCT levels is displayed in Figure 1 and Figure 2.
Conclusion: The distribution of PCT values above and below the threshold for recommending antibiotic stopping was similar at our two academic MICUs, but MD adherence to these recommendations differed markedly, suggesting variable test acceptance. Only 20% of patients in the MICU with higher rates of adherence had PCT levels below the threshold to recommend stopping antibiotics. PCT testing after ICU discharge and improved MD education may be needed to take full advantage of PCT testing in this population.
D. N. Schwartz,
S. R. Peglow, None
R. D. Lyles, None
R. Gueret, None
R. Xamplas, None
K. Singh, Quidel: Scientific Advisor, Consulting fee
W. Niklinski, None
R. Cypser, None
L. Fogg, None
R. A. Weinstein, None
R. Balk, Biomerieux: Research and Speaker's Bureau, Research support and Speaker honorarium