1501. Impact of a Procalcitonin-based Treatment Guideline on Antibiotic Prescribing in Cardiology Patients with Suspected Respiratory Tract Infection
Session: Poster Abstract Session: Antimicrobial Stewardship: Role of Diagnostics
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • PCT in Cardiology Pts with RTI_IDWeek 2015.pdf (150.9 kB)
  • Background:

    The utility of procalcitonin (PCT) in guiding antibiotic (ABX) decisions for respiratory tract infections (RTI) is established. Cardiology (CAR) patients may benefit from PCT as ABX are often prescribed in response to respiratory symptoms and nonspecific chest x-ray (CXR) findings (e.g. possible pulmonary edema). The objective of this study was to determine the impact of a PCT-guideline on ABX prescribing among CAR patients with suspected RTI.

    Methods:

    This was a single-center, observational study. Measures of ABX usage were collected 1 year before and after PCT-guideline implementation (Jan 2014). The PCT-guideline recommended PCT at day 4 of ABX to guide duration. Patients were randomly selected within each time period. Inpatient and outpatient ABX usage was recorded. Patients were ≥18 years, on a CAR service, and prescribed ABX for suspected RTI. Excluded patients had sepsis, cardiac surgery, cardiac arrest, cardiogenic shock, ventricular assist device, immunosuppression, concomitant infection, or ABX before admission. 

    Results:

    Thirty-seven patients were included in each group. There was no difference in patient characteristics. Median length of stay (LOS) was 5 days for both groups. Twenty-four patients in the after group were PCT-guideline eligible based on LOS ≥4 days; a PCT was ordered for 17 (71%) of these (PCT subgroup). Most patients had a PCT <0.25 ng/ml (76%). ABX usage was less in the after group and PCT subgroup (Table). One patient developed C. difficile colitis (before group), and none died during hospitalization.

     

    ABX duration, days1

    DDDs2, median (range)

    DOTs3

    AFDs4 to day 14

    Inpatient AFDs

    Before Group (n=37)

    7.5 (2.7)

    8.7 (2-24)

    9.9 (4.6)

    6.6 (2.5)

    0.2 (0.6)

    After Group (n=37)

    6.6 (2.3), p=0.114

    7.0 (3-37), p=0.268

    8.9 (5.1), p=0.391

    7.5 (2.2), p=0.107

    0.9 (1.8), p=0.022

    PCT Subgroup (n=17)

    6.0 (2.0), p=0.046

    6.0 (3-15), p=0.147

    9.1 (4.1), p=0.538

    7.9 (2.0), p=0.059

    1.7 (2.3), p<0.001

    1Results reported as mean (SD) unless noted, 2Defined daily doses, 3Days of therapy, 4Antibiotic free days

    Conclusion:

    A PCT-guideline is a useful tool to decrease ABX among CAR patients who often receive ABX due to respiratory symptoms and non-specific CXR findings.

    Katie Wallace, PharmD1, Monty Yoder, PharmD1, James Beardsley, PharmD1,2, James Johnson, PharmD1,2, Vera Luther, MD2, Christopher Ohl, MD, FIDSA2 and John Williamson, PharmD1,2, (1)Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, (2)Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC

    Disclosures:

    K. Wallace, None

    M. Yoder, None

    J. Beardsley, None

    J. Johnson, None

    V. Luther, None

    C. Ohl, None

    J. Williamson, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.