1968. Procalcitonin-guided antibiotic therapy for lower respiratory tract infections in a US academic medical center
Session: Poster Abstract Session: Clinical Trials
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • PCT Poster revised 9.2018.pdf (653.4 kB)
  • Background: European trials using procalcitonin (PCT)-guided antibiotic therapy for patients with lower respiratory tract infections (LRTI) have resulted in significant reductions in antibiotic use without increasing adverse outcomes. Few prospective studies have examined PCT-guided antibiotic therapy for LRTI in the US. Our objective was to examine whether a PCT algorithm compared to standard practice would reduce antibiotic exposure in patients with LRTI [pneumonia and acute exacerbations of chronic obstructive pulmonary disease (AECOPD)] in an American urban academic hospital.

    Methods: From 04/17/17 until 11/01/17, consecutive patients admitted to a medicine service were enrolled in the PCT intervention if they were receiving antibiotics for LRTI and gave consent. Providers were encouraged to discontinue antibiotics using a PCT algorithm with predefined cutoffs. Serum PCT was measured in the hospital lab once daily. Results and recommendations were communicated to providers by study team and in the medical record. Control patients were selected by reviewing charts for patients admitted to a medicine service for LRTI from 12/1/2016 to 04/16/17. The primary endpoint was median antibiotic duration. Overall adverse outcomes at 30 days comprised death, transfer to an intensive care unit, antibiotic side effects, Clostridium difficile infection, disease- specific complications, and new antibiotic prescription for LRTI after discharge.

    Results: 174 patients were enrolled in the intervention group and 200 patients in the control group. Intervention group providers complied with the PCT algorithm in 75% of encounters. The rate of overall adverse outcomes was similar in PCT and control groups (21.8% vs 23.5%; difference, -0.02; 95% CI, -0.10 to 0.07). PCT-guided therapy reduced the median antibiotic duration for pneumonia from 7 days to 6 (p=0.05), and AECOPD from 4 days to 3 (p=0.01). Noncompliance with the PCT algorithm resulted in 260 excess antibiotic days in 44 patients.

    Conclusion: In our center, 75% adherence to a PCT-guided algorithm safely reduced the duration of antibiotics for treating LRTI. Incentivizing providers to comply with PCT-guided algorithms could lead to further reductions in antibiotic use.

    Jennifer Townsend, MD1, Victoria Adams-Sommer, PharmD2, Panagis Galiatsatos, MD2, David Pearse, MD3, Flora Kisuule, MD4, Hardin Pantle, MD5, Mary Masterson, PA-C5, Catherine Kiruthi, PharmD2, Paul Ortiz, PharmD6, Elsen Jacob, PharmD2, Jacob Sama, MD2, Michael Melgar, MD2, Seema Nayak, MD7, Jillian Irwin, MD7, Cyrus Mazidi, MD2, Sam Stern, MD2, Albert Agbanlog, RN2, Robert Jurao, RN2, Kevin Psoter, PhD, MPA2 and Robin McKenzie, MD2, (1)Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, (2)Johns Hopkins Bayview Medical Center, Baltimore, MD, (3)Pulmonary and Critical Care, Johns Hopkins Bayview Medical Center, Baltimore, MD, (4)Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, (5)Emergency Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, (6)Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, (7)Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD

    Disclosures:

    J. Townsend, BRAHMS: Grant Investigator , Research grant .

    V. Adams-Sommer, None

    P. Galiatsatos, None

    D. Pearse, None

    F. Kisuule, None

    H. Pantle, None

    M. Masterson, None

    C. Kiruthi, None

    P. Ortiz, None

    E. Jacob, None

    J. Sama, None

    M. Melgar, None

    S. Nayak, None

    J. Irwin, None

    C. Mazidi, None

    S. Stern, None

    A. Agbanlog, None

    R. Jurao, None

    K. Psoter, None

    R. McKenzie, None

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