Decreased antibiotic exposure using a procalcitonin protocol for respiratory infections and sepsis in US community hospitals (ProCommunity)

Abstract

Objective

Antibiotic overuse leading to antimicrobial resistance is a global public health concern. Clinical trials have demonstrated that procalcitonin-based decision-making for antibiotic therapy can safely decrease inappropriate antibiotic use in patients with respiratory infections and sepsis, but real-world data are scarce. This study sought to assess the impact of a procalcitonin-based antibiotic stewardship program (protocol plus education) on antibiotic use in community hospitals.

Methods

An observational, retrospective, matched cohort study was conducted. Eligible patients treated in hospitals with a procalcitonin-based protocol plus education (Procalcitonin cohort hospitals) were matched to patients admitted to facilities without procalcitonin testing (Control cohort hospitals) using a 1:2 ratio. The Control hospitals were facilities where procalcitonin testing was not available on site. Patient matching was based on: (1) age, (2) gender, (3) admission diagnosis code using groupings of the International Classification of Diseases, 10th Revision, (4) whether patients were admitted to the intensive care unit, and (5) whether a blood culture test was performed. Procalcitonin cohort hospitals implemented a quality improvement initiative, where procalcitonin was available, used regularly, and clinicians (physicians and pharmacists) were educated on its use.

Results

After adjustment, patients in the Procalcitonin cohort had 1.47 fewer antibiotic days (9.1 vs. 8.5 days, 95%CI: −2.72; −0.22, p = .021). There was no difference in length of stay or adverse clinical outcomes except for increase in acute kidney injury (odds ratio = 1.26, 95%CI: 1.01; 1.58, p = .038).

Conclusions

Patients with respiratory infections and sepsis in hospitals utilizing a procalcitonin-based protocol coupled with education received fewer days of antibiotic therapy.

Keywords:

• Procalcitonin
• sepsis
• drug resistance
• microbial
• infections
• hospitals

Transparency

Declaration of funding

This work was supported by bioMérieux, Inc. bioMérieux is the manufacturer of the VIDAS family of instruments for the determination of procalcitonin in human serum or plasma (lithium heparinate) using the ELFA (Enzyme-Linked Fluorescent Assay) technique. B·R·A·H·M·S PCTⁱⁱ is the property of Thermo Fisher. The study sponsor was involved in the study design (definition of the research objective and identification of the data source), the interpretation of data (review and interpretation of initial results), the review and approval of the manuscript, and the decision to submit the manuscript for publication.

Declaration of financial/other relationships

KD and SI are former employees of CHSPSC, LLC. PS has received research funding from bioMérieux SA, bioMérieux, Inc., Thermofisher, Roche, Siemens and Abbott. PT-L, NK, HCC, and SO are employees of Analysis Group, Inc., a consultancy that has received research funding from bioMérieux for participation in this study. TV has received research funding from Merck and Rebiotix and served as a consultant for bioMérieux. LZ is an employee of bioMérieux, Inc. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors agree to be accountable for all aspects of the work.

Acknowledgements

The authors would like to thank Yi Zhong for her assistance with data analysis.

Notes

i Sentri7 is a registered trademark of Wolters Kluwer Health, Madison, WI, USA.

ii B·R·A·H·M·S PCT is a trademark of Thermo Fisher Scientific Inc., Waltham, MA, USA.