1971. Impact of Procalcitonin Guidance on Management of Adults Hospitalized with COPD Exacerbations 
Session: Poster Abstract Session: Clinical: Respiratory Track
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • COPD PCT ID Week 2017 poster - Final.pdf (203.4 kB)
  • Background: Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but there remains limited data on the impact of PCT guidance on the management of COPD exacerbations.

    Methods: A retrospective, pre-intervention/post-intervention study was conducted to compare the management of patients admitted with COPD exacerbations before and after implementation of PCT guidance at two teaching hospitals in Pittsburgh, Pennsylvania. The pre-intervention period was 3/1/2014-10/31/2014, and the post-intervention period was 3/1/2015-10/31/2015. The primary outcome was duration of antibiotic therapy for COPD. Secondary objectives included duration of IV antibiotics, duration of inpatient length of stay (LOS), and 30-day readmission rates.

    Results: There were no differences in mean age (66.2 vs 65.9; p=0.82) or use of home oxygenation (65% vs 61%; p=0.67) in the pre-intervention and post-intervention groups, respectively. Primary and secondary outcomes can be seen in Table 1.

    In the post-intervention group, 16/139 (11.5%) patients had an elevated PCT (> 0.25 µg/L). Patients with an elevated PCT received longer durations of antibiotics compared to those with low PCT levels (5.3 vs 2.7; p=0.001).

    Table 1: Treatment duration and outcomes of total cohorts

    Pre- Intervention 

    (n=166)

    Post-Intervention (n=139)

    P value

    Duration of total antibiotics, mean (SD), days

    5.3 (3.2)

    3.0 (2.9)

    0.01

    Duration of IV antibiotics, mean (SD), days

    2.5 (2.4)

    1.9 (1.8)

    0.02

    Duration 0 - 1 days, n (%)

    24 (14.5)

    61 (43.8)

    Duration 2 - 5 days, n (%)

    73 (44.0)

    48 (34.6)

    Duration 6-7 days, n (%)

    37 (22.3)

    18 (13.0)

    Duration 8-10, n (%)

    23 (13.8)

    10 (7.2)

    Duration 11-14, n (%)

    8 (4.8)

    2 (1.4)

    Duration > 14, n (%)

    1 (0.6)

    0 (0)

    Inpatient LOS, mean (SD), days

    4.1 (3.9)

    2.9 (2.0)

    0.01

    Readmission within 30 days, n (%)

    24 (14.5)

    23 (16.6)

    0.25

    Respiratory related 30-day readmission, n (%)

    18 (10.8)

    13 (9.4)

    0.18

    SD= standard deviation

    Conclusion: Utilizing PCT guidance in the management of COPD exacerbations decreased both the total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions.

    Derek Bremmer, PharmD, BCPS, Briana DiSilvio, MD, Crystal Hammer, MD, Moeezullah Beg, MD, Swati Vishwanathan, MD, Daniel Speredelozzi, MD, Matthew Moffa, DO, Kurt Hu, MD, Rasha Abdulmassih, MD, Jina Makadia, MD, Rikinder Sandhu, MD, Mouhib Naddour, MD, Noreen Chan-Tompkins, PharmD, BCPS - AQ ID, Tamara Trienski, PharmD, Courtney Watson, MPH and Thomas Walsh, MD, Allegheny Health Network, Pittsburgh, PA

    Disclosures:

    D. Bremmer, None

    B. DiSilvio, None

    C. Hammer, None

    M. Beg, None

    S. Vishwanathan, None

    D. Speredelozzi, None

    M. Moffa, None

    K. Hu, None

    R. Abdulmassih, None

    J. Makadia, None

    R. Sandhu, None

    M. Naddour, None

    N. Chan-Tompkins, None

    T. Trienski, None

    C. Watson, None

    T. Walsh, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.