Background: Procalcitonin (PCT) is a proven tool to guide optimal antibiotic utilization. Physician attitudes towards PCT play a critical role in optimal PCT use. This study was an initial step in developing an antibiotic stewardship intervention for antibiotic de-escalation targeting physician trainees.
Methods: We used an electronic mailing list to distribute an anonymous survey to all internal medicine residents. The survey included 13 multiple-choice questions to assess attitudes and self-reported use of PCT and 3 case-based questions to gauge application of PCT in clinical practice. Residents provided gift cards as an incentive for completion.
Results: A total of 94% (113/120) of residents responded to the survey. Only 22% reported using PCT prior to residency. One-third of residents order PCT at admission and 48 hours later for patients with suspected infections, while another third order PCT on admission only.
Most found an elevated PCT useful (> or = 3 on a scale from 1-5, 5 most useful), with 84% stating PCT helps in discontinuing antibiotics. When asked why PCT was unhelpful, 71% of residents found it difficult to interpret and 48% reported PCT does not change management. Almost all residents desired additional PCT education. Half of residents thought point of care PCT interpretation in the electronic medical record (EMR) would be valuable.
In the case-based questions, 77% did not start antibiotics for a patient with an elevated PCT and no infectious symptoms. In another case, 81% chose to stop empiric antibiotics on day 7 for a patient with unspecified sepsis with clinical improvement, negative infectious workup and PCT of 0.2 ng/dL (figure 1).
Conclusion: Despite over two thirds of residents reporting uncertainty with PCT, the majority of residents interpreted PCT correctly within the case-based questions to de-escalate antibiotics. Based upon these results, we will implement point of care PCT guidelines in the EMR as part of the antibiotic timeout. We will further validate reported PCT use by analysis of EMR data on PCT ordering rates among residents.
Figure 1: Responses for case-based question for clinical management of undifferentiated sepsis started on empiric antibiotics with procalcitonin of 0.2 ng/dL on day 7 and negative blood, urine and sputum cultures
Figure 2: Current procalcitonin order
K. Evans, None
K. Swenson, None
M. Holubar, None