Impact of Procalcitonin (PCT)-Guided Antibiotic Management on Antibiotic Exposure and Outcomes: Real World Evidence

BACKGROUND: Antibiotic overuse and misuse, the main causes of antibiotic resistance, often result from lack of diagnostic clarity. Delayed pathogen identification paired with nonspecific clinical findings may leave clinicians with insufficient evidence to make definitive decisions regarding the need for antibiotics. The dual stimulus of bacterial toxins and inflammation make Procalcitonin (PCT) unique in its ability to differentiate bacterial infection from other causes of inflammation and thus useful for antibiotic management. The objective of our study was to evaluate the impact of a PCT-guided algorithm (PCT-A) on current practice. METHODS: A single-center, retrospective cohort study was conducted to evaluate the impact of adding PCT-A to current stewardship practices. Patient data from four years prior to and four years after PCT-A implementation was compared in critical and acute care patients of all ages receiving parenteral antibiotics for a DRG coded for infection. A baseline PCT was obtained at the time of admission in all patients with suspected or proven bacterial infection. Serial PCT measurements were repeated at 24 hour intervals to evaluate effectiveness of therapy. Outcomes of interest were antibiotic exposure, mortality, 30-day readmission, C. difficile infection (CDI) and adverse drug events (ADE). RESULTS: 985 patients in the pre PCT-A group were compared with 1167 patients in the post PCT-A group. Antimicrobial stewardship alone in the pre PCT-A group resulted in a median Days of Therapy (DOT) of 17.0 (IQR 8.5–22.5) vs. 9.0 (IQR 6.5–12.0) in the post PCT-A group (between-group difference -8.0 DOT, P < 0.0001). Mortality, readmission, CDI and ADEs were also significantly reduced (-51%, -37%,-60%, -41% respectively) in the post PCT-A group. CONCLUSION: The addition of PCT to clinical judgment and antibiotic management practices in a facility with an established stewardship program resulted in a significant reduction in antibiotic exposure and adverse outcome. PCT may improve antibiotic management in situations where diagnostic clarity and resolution of infection are lacking. DISCLOSURES: M. Broyles, Roche Diagnostics: Scientific Advisor, Consulting fee and Educational grant; Thermo Fisher Scientific: Scientific Advisor, Consulting fee and Educational grant; bioMerieux: Scientific Advisor, Speaker honorarium