Efficacy of Procalcitonin-Guided Antimicrobial Stewardship Initiative for Diagnosing Pneumonia
Implementation of a procalcitonin diagnostic algorithm improves diagnostic yield and reduces hospital length of stay in bacterial pneumonia.
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SAN DIEGO – Implementation of an antimicrobial stewardship program using serum procalcitonin levels for diagnosis and management of presumed pneumonia was shown to decrease length of hospital stay and improve the targeting of appropriate therapy, according to a study presented at IDWeek 2017.
In this retrospective study, 182 adult patients were evaluated for pneumonia using serum procalcitonin levels. Duration of antibiotic use was guided by subsequent procalcitonin tests over the following 7 days. All emergency department staff were provided with education by the antimicrobial stewardship program prior to initiation of the program.
Patients who tested negative for procalcitonin were younger (78 vs 84; P =.04) and more likely to be women (88 vs 15; P =.001) compared with patients who tested positive for procalcitonin. Negative procalcitonin was also associated with lower temperature (P <.001) and lower white blood cell count on admission (P <.001).
Compared with patients who tested positive for procalcitonin, patients who tested negative had lower rates of antibiotic initiation (95% vs 71%; P =.001) and lower rates of admission (98% vs 89%; P =.08). Moreover, patients who tested negative for procalcitonin had reduced duration of antibiotics (P <.001) and shorter lengths of stay (P =.004). No differences in 30-day pneumonia readmission were noted between the two groups.
No adverse events related to procalcitonin screening were reported.
The investigators concluded that "implementation of a [procalcitonin] algorithm through [an antimicrobial stewardship program] is a novel and efficacious addition to improving diagnostic yield, targeting appropriate therapy, and reducing length of stay. The impact on antibiotic resistance remains to be determined."
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Rodriguez GD, Yashayev R, Yushuvayev B, et al. A novel antimicrobial stewardship program-guided procalcitonin initiative for emergency department diagnosis of bacterial pneumonia in New York City. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, California. Oral Abstract 958.