Procalcitonin (PCT) based guidelines used in conjunction with antimicrobial stewardship programs (ASP) have been shown to reduce the initiation and duration of antibiotic use without compromising patient safety. However, the data on PCT use for antimicrobial stewardship in community hospitals is scarce. The objective of this study was to evaluate the impact of using PCT with active intervention by an ASP physician on inpatient length of stay (LOS) and antimicrobial length of therapy (LOT) at a community hospital.
Patients reviewed by the ASP at a 365-bed community hospital from May 2013 to April 2014 were retrospectively reviewed. Patients with at least 1 PCT level were included (normal PCT level was defined as <0.25ng/ml or 90% less than the peak value). Additional data collected included diagnoses, overall LOS, antimicrobial LOT, and prescriber acceptance of recommendations from the ASP. Descriptive analyses were used for LOS and antibiotic LOT. Effect of the acceptance of ASP PCT-guided recommendations on LOS and antibiotic LOT was assessed using ANOVA analyses and/or Kruskall Wallis. All statistical analyses were performed using SAS Version 9.4 (Cary, NC) with significant statistical differences defined as P < 0.05.
A total of 857 cases were included. Overall mean LOS was longer in patients with abnormal PCT levels than patients with normal PCT levels (9.13 vs. 7.92 days; = 2.84; chi-squared = 2.94, P = 0.09). Patients in whom ASP recommendations were accepted after PCT results were available had a significantly shorter antimicrobial LOT (2.50 vs. 3.93 days; chi-squared = 40.94, P < 0.01) and a significantly shorter total antimicrobial LOT (5.10 vs. 6.55 days; chi-squared = 19.50 , P < 0.01) when compared with patients in whom ASP recommendations were not accepted; the mean LOS was similar between these groups of patients (8.46 vs. 8.21 days; = chi-squared = 1.64, P = 0.20).
PCT-guided protocols in conjunction with active intervention by an ASP in a community hospital can result in a reduction of antimicrobial LOT.
J. Newton Jr.,
S. Robinson, None
K. Kuper, None
K. W. Garey, Merck & Co.: Grant Investigator , Research grant
Summit Pharmaceuticals: Grant Investigator , Research support
K. K. Trivedi, None