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Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship
BACKGROUND: Procalcitonin testing has been adopted by antimicrobial stewardship programs as a means of reducing inappropriate antibiotic use, including within intensive care units (ICUs). However, concerns regarding procalcitonin’s sensitivity exist. The purpose of this study is to calculate the sen...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162616/ https://www.ncbi.nlm.nih.gov/pubmed/32322602 http://dx.doi.org/10.1093/ofid/ofaa096 |
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author | Goodlet, Kellie J Cameron, Emily A Nailor, Michael D |
author_facet | Goodlet, Kellie J Cameron, Emily A Nailor, Michael D |
author_sort | Goodlet, Kellie J |
collection | PubMed |
description | BACKGROUND: Procalcitonin testing has been adopted by antimicrobial stewardship programs as a means of reducing inappropriate antibiotic use, including within intensive care units (ICUs). However, concerns regarding procalcitonin’s sensitivity exist. The purpose of this study is to calculate the sensitivity of procalcitonin for bacteremia among hospitalized patients. METHODS: This was a retrospective cohort study of adult patients admitted to an academic medical center between July 1, 2018, and June 30, 2019, with ≥1 positive blood culture within 24 hours of admission and procalcitonin testing within 48 hours. Low procalcitonin was defined as <0.5 µg/L. RESULTS: A total of 332 patients were included. The sensitivity of procalcitonin for bacteremia was 62% at the sepsis threshold of 0.5 µg/L, 76% at a threshold of 0.25 µg/L, and 92% at a threshold of 0.1 µg/L. Of the 125 patients with low procalcitonin, 14% were initially admitted to the ICU and 9% required the use of vasopressors. In that same group, the top 3 organisms isolated were Staphylococcus aureus (39%), Escherichia coli (17%), and Klebsiella spp. (7%). Compared with those patients with elevated procalcitonin, patients with low procalcitonin were significantly more likely to have >24-hour delayed receipt of antibiotic therapy (3% vs 8%; P = .04), including among patients admitted to the ICU (1% vs 18%; P = .02). CONCLUSIONS: The sensitivity of procalcitonin for bacteremia is unacceptably low for a rule-out test. Antimicrobial stewardship programs should use caution before promoting the withholding of antibiotic therapy for patients with low initial procalcitonin values. |
format | Online Article Text |
id | pubmed-7162616 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-71626162020-04-22 Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship Goodlet, Kellie J Cameron, Emily A Nailor, Michael D Open Forum Infect Dis Major Article BACKGROUND: Procalcitonin testing has been adopted by antimicrobial stewardship programs as a means of reducing inappropriate antibiotic use, including within intensive care units (ICUs). However, concerns regarding procalcitonin’s sensitivity exist. The purpose of this study is to calculate the sensitivity of procalcitonin for bacteremia among hospitalized patients. METHODS: This was a retrospective cohort study of adult patients admitted to an academic medical center between July 1, 2018, and June 30, 2019, with ≥1 positive blood culture within 24 hours of admission and procalcitonin testing within 48 hours. Low procalcitonin was defined as <0.5 µg/L. RESULTS: A total of 332 patients were included. The sensitivity of procalcitonin for bacteremia was 62% at the sepsis threshold of 0.5 µg/L, 76% at a threshold of 0.25 µg/L, and 92% at a threshold of 0.1 µg/L. Of the 125 patients with low procalcitonin, 14% were initially admitted to the ICU and 9% required the use of vasopressors. In that same group, the top 3 organisms isolated were Staphylococcus aureus (39%), Escherichia coli (17%), and Klebsiella spp. (7%). Compared with those patients with elevated procalcitonin, patients with low procalcitonin were significantly more likely to have >24-hour delayed receipt of antibiotic therapy (3% vs 8%; P = .04), including among patients admitted to the ICU (1% vs 18%; P = .02). CONCLUSIONS: The sensitivity of procalcitonin for bacteremia is unacceptably low for a rule-out test. Antimicrobial stewardship programs should use caution before promoting the withholding of antibiotic therapy for patients with low initial procalcitonin values. Oxford University Press 2020-03-16 /pmc/articles/PMC7162616/ /pubmed/32322602 http://dx.doi.org/10.1093/ofid/ofaa096 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Major Article Goodlet, Kellie J Cameron, Emily A Nailor, Michael D Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship |
title | Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship |
title_full | Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship |
title_fullStr | Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship |
title_full_unstemmed | Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship |
title_short | Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship |
title_sort | low sensitivity of procalcitonin for bacteremia at an academic medical center: a cautionary tale for antimicrobial stewardship |
topic | Major Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162616/ https://www.ncbi.nlm.nih.gov/pubmed/32322602 http://dx.doi.org/10.1093/ofid/ofaa096 |
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