228. Procalcitonin Utilization in Patients Hospitalized with Pneumonia in Michigan Hospitals: A Cohort Study
Session: Poster Abstract Session: Diagnostics: Use of Biomarkers
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Procalcitonin ID week poster Updated 1995 patients 10_18.pdf (143.2 kB)
  • Background:

    Antibiotic misuse leads to bacterial resistance, adverse events, and an increased risk of Clostridium difficile. Despite these risks, providers often prescribe antibiotics for viral infections and treat bacterial lower respiratory tract infections (LRTIs) too long.  Serum procalcitonin (PCT)-guided initiation and discontinuation of antibiotics in LRTIs has been shown to reduce antibiotic use. Despite this promise, its adoption remains limited and patterns of use are not well described. We therefore analyzed current use of PCT in patients hospitalized with LRTIs.

    Methods:

    Trained abstractors collected data between November 2015 and April 2016 on 1,047 non-ICU general medical patients hospitalized with LRTI (discharge diagnosis of LRTI plus symptoms within 48 hours of admission) at 10 diverse Michigan hospitals. LRTI signs and symptoms, antibiotic use, and clinical outcomes were collected. Data were analyzed using logistic or linear regression with adjustment for hospital clustering.

    Results:
    Half (5/10, 50%) of hospitals had PCT testing available. Within those hospitals, use varied widely (Figure 1). Of 1047 patients, 249 patients had PCT levels measured at least once (Figure 2). Only 39.8% (99/249) of initial PCT labs were positive (≥0.25 ng/ml). Patients with negative values had repeat testing 22.7% (34/150) of the time, with only four cases turning positive (Figure 3).

    Of patients who had a PCT ordered, 45.4% (113/249) had acute or chronic kidney disease (AKI, CKD). Compared to patients without AKI or CKD, patients with CKD were more likely to have a positive PCT (OR 1.82, 95% CI: 1.29, 2.56, p=0.001) but patients who developed AKI without CKD were not (OR 1.05, 95% CI: 0.43, 2.52, p=0.921). All patients on dialysis (9/9) had a positive PCT.

    Patients with a negative PCT received fewer days of antibiotics (8.4 days, 95% CI: 7.8, 9.1) than those with a positive PCT (9.9 days, 95% CI: 9.1, 10.7, p<0.001) but were not different from those without PCT testing (8.6 days, 95% CI: 7.6, 9.7, p=0.687).

    Conclusion:

    There is wide variation in availability and use of PCT in Michigan hospitals. Only 22.7% of negative PCTs had repeat testing despite antibiotic continuation. Compared with no testing, a negative PCT was not associated with shorter antibiotic use.

     

     

    Valerie Vaughn, MD1, Tejal Gandhi, MD2, Anurag Malani, MD, FIDSA3, Rama Thyagarajan, MD4, Anna Conlon, PhD5, Daniel Nielsen, MS5 and Scott Flanders, MD1, (1)Internal Medicine, University of Michigan, Ann Arbor, MI, (2)Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI, (3)St. Joseph Mercy Health System, Ypsilanti, MI, (4)Internal Medicine/Infectious Disease, Beaumont Health- Dearborn, Dearborn, MI, (5)University of Michigan Health System, Ann Arbor, MI

    Disclosures:

    V. Vaughn, None

    T. Gandhi, None

    A. Malani, None

    R. Thyagarajan, None

    A. Conlon, None

    D. Nielsen, None

    S. Flanders, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.