The use of a PCT algorithm in patients with community-acquired PNA has been shown to decrease the duration of antimicrobial therapy. The impact of negative PCT levels on antimicrobial exposure in patients with an admission diagnosis of PNA is unknown.
A retrospective chart review was conducted. Patients were screened for an admission diagnosis of PNA. The historical cohort (control) consisted of patients without an ICD-9 code for PNA upon discharge. The PCT cohort included patients with a PCT level of < 0.25 obtained within 48 hours of antimicrobial therapy. Demographic data were collected. The primary outcome was inpatient, outpatient and total antibiotic exposure measured in days of therapy (DOT). Secondary outcomes included length of stay, mortality and 30-day readmissions for PNA.
1033 patients were screened and after exclusion criteria were applied, there were 104 patients in the control group and 99 in the PCT group. Baseline demographics including Charlson Score, sex, age, and co-morbidities were similar between the 2 groups. A significant reduction in both inpatient and total antibiotic DOTs was seen when comparing the control group with the PCT group, 4.69 ±2.96 days(SD) versus 3.37 ± 2.26 days (P=0.0005) and 8.33 ± 4.53 versus 6.30 ± 4.04 days (p=0.0016), respectively. There was no difference in outpatient DOTs. (See Figure 1)
In a sub-group analysis, 55 patients in the PCT group were found to have a discharge ICD-9 code for PNA and were excluded to make the control and PCT groups more comparable.
The remaining cohort of 54 PCT patients without a discharge ICD-9 code for PNA showed a significant reduction in DOTs across all strata when compared to the control group. (See Figure 2)
Reduction of antimicrobial exposure had no significant impact on secondary outcomes of length of stay, ICU stay, hospital mortality, 14-day mortality, 30-day mortality or, 30-day readmission for PNA.
A negative PCT level in patients admitted with suspected PNA and even with a discharge diagnostic ICD-9 code for PNA was associated with decreased antimicrobial exposure. The impact of a negative PCT level can be used as a metric for antimicrobial stewardship programs and would justify a return on investment.
C. Vu, None
A. Perreiter, None
R. Chinn, None