2242. Use of a Procalcitonin Assay in Hospitalized Patients for CHF Reduced Subsequent Use of Antibiotics

BACKGROUND: Procalcitonin (PCT) is a biomarker that rises in bacterial infections and is being increasingly used to support a diagnosis of bacterial pneumonia. In addition, it may be used in cases in which the diagnosis is not clear such as in patients with congestive heart failure (CHF), which may mimic the signs and symptoms of bacterial pneumonia. The PCT assay was implemented at our institution to reduce unnecessary antimicrobial use when evaluating patients for suspected pneumonia. METHODS: We performed a retrospective analysis of all patients with a discharge diagnosis of CHF, admitted in a 6-month period, to a large community teaching hospital. Patients with documented pneumonia were excluded. Data were collected on demographics, comorbidities to calculate the Charlson Weighted Index of Comorbidity (CWIC) score, clinical and laboratory information, PCT results (if collected), whether antimicrobials were used, and if so, duration of therapy. Data were analyzed using the Mann–Whitney U test. RESULTS: We reviewed 299 charts, with 198 (66.2%) included for analysis. The mean age was 70.4 ± 15.0 years, 53% female and 49.5% black. PCT testing was done in 72 (36%) patients; 117 (59%) had antimicrobials given in the emergency department (ED). If the PCT was performed, patients were more likely to receive antibiotics in the ED (79.2% vs. 47.6%, P < 0.0001). Patients who had a PCT drawn were less likely to have antibiotics continued after discharge from the ED (27.6% vs. 73.3%, P < 0.0001). The median duration of antimicrobials was shorter in patients who had a PCT level drawn than those who did not, 1 day (range 0.5–14) vs. 3 days (0.5–61), P < 0.0001. The duration of antimicrobials also tended to be shorter in patients with PCT levels ≤ 0.25 compared with those with levels >0.25, 0.5 days (0.5–12) vs. 1.0 day (0.5–14), p = 0.06. CONCLUSION: Among patients with a discharge diagnosis of CHF, there was an association between the use of the PCT assay and both discontinuation of antibiotics given in the ED as well as decreased duration of antimicrobials in patients. These results support the ongoing use of this test to promote antimicrobial stewardship. DISCLOSURES: All authors: No reported disclosures.