Impact of Procalcitonin Levels Combined With Active Intervention on Antimicrobial Stewardship in a Community Hospital

BACKGROUND: Procalcitonin (PCT) guidance alone or in conjunction with antibiotic stewardship programs (ASPs) has been shown to reduce antibiotic utilization and duration of therapy without adversely affecting patient outcomes. METHODS: In a community hospital, we investigated the impact of PCT with ASP recommendations on length of stay (LOS), length of antimicrobial therapy (LOT) after ASP recommendation, and total LOT over a 1-year period. Adult patients with at least 1 PCT value and concomitant ASP recommendations were included. Patients were grouped by provider ASP compliance and further stratified by normal versus elevated PCT values. No specific PCT algorithm was utilized. RESULTS: A total of 857 patients were retrospectively analyzed. Physicians complied with 73.7% of ASP recommendations. There were no significant differences in LOS based on ASP compliance. Mean LOT after ASP recommendations and mean total LOT were significantly shorter (2.5 vs 3.9 days, P < .0001 and 5.1 vs 6.6 days, P < .0001, respectively) in the ASP complier group. When stratified by initial PCT levels, ASP compliers for patients with normal PCT levels had the shortest duration of therapy for all groups; among patients with elevated PCT levels, the duration of therapy was significantly shorter in the ASP compliant group (5.79 vs 7.12 days, P < .0111). When controlling for baseline differences in initial PCT levels, LOS was found to be marginally shorter in the ASP compliant group (P = .076). CONCLUSIONS: Procalcitonin-guided ASP physician recommendations, when accepted by providers, led to reduction in LOT in a community hospital. This benefit was extended across patient groups irrespective of initial PCT levels.