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Impact of Procalcitonin Monitoring on Duration of Antibiotics in Patients With Sepsis and/or Pneumonia in a Community Hospital Setting.

ABSTRACT: Background: Procalcitonin (PCT) is a biomarker specific for bacterial infections versus viral or noninfectious causes. Utilizing PCT as a guide for antibiotic duration could have benefit in limiting antimicrobial overuse. Objective: The objective of this study was to analyze the effect of PCT monitoring on inpatient antibiotic duration for pneumonia and sepsis at a community hospital. Methods: This study utilized a prospective cohort design with a historical control group prior to the availability of PCT testing and a prospective intervention group after the availability of PCT testing at a community hospital. Results: A total of 102 patients (51 retrospective and 51 prospective) were included in the analysis. There was no difference in mean duration of inpatient antibiotics (6.1 ± 3.9 vs 5.4 ± 2.9 days, P = .50). Additionally, there was no difference in the average time to antibiotic de-escalation, average hospital length of stay, or intensive care unit length of stay. PCT monitoring resulted in a 41% reduction in discharge antibiotics (63% vs 37%, P = .0090) and a 2.2-day reduction in duration of overall inpatient and post-discharge antibiotics (9.5 ± 4.5 vs 7.3 ± 4.1 days, P = .013). There was no difference in mortality, relapse of infection, or 30-day readmission. Conclusion: PCT monitoring in patients with suspected pneumonia and/or sepsis in the community setting failed to show a reduction in duration of inpatient antibiotics after the introduction of PCT monitoring. However, PCT resulted in significantly fewer discharge antibiotics and overall inpatient plus post-discharge antibiotic duration, with no detrimental effect on mortality or readmission.

SUBMITTER: Covington EW

PROVIDER: S-EPMC6580727 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Impact of Procalcitonin Monitoring on Duration of Antibiotics in Patients With Sepsis and/or Pneumonia in a Community Hospital Setting.

Covington Elizabeth W EW Eure Stephen S Carroll Doug D Freeman Christen C

The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians 20180206 3

Background: Procalcitonin (PCT) is a biomarker specific for bacterial infections versus viral or noninfectious causes. Utilizing PCT as a guide for antibiotic duration could have benefit in limiting antimicrobial overuse. Objective: The objective of this study was to analyze the effect of PCT monitoring on inpatient antibiotic duration for pneumonia and sepsis at a community hospital. Methods: This study utilized a prospective cohort design with a historical control group pr ...[more]

PMID: 34861025

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Project description:BackgroundHospital-acquired pneumonia is one of the most common hospital-acquired infections in children worldwide. Most of our understanding of hospital-acquired pneumonia in children is derived from adult studies. To our knowledge, no systematic review with meta-analysis has assessed the benefits and harms of different antibiotic regimens in neonates and children with hospital-acquired pneumonia.ObjectivesTo assess the beneficial and harmful effects of different antibiotic regimens for hospital-acquired pneumonia in neonates and children.Search methodsWe searched CENTRAL, MEDLINE, Embase, three other databases, and two trial registers to February 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies.Selection criteriaWe included randomised clinical trials comparing one antibiotic regimen with any other antibiotic regimen for hospital-acquired pneumonia in neonates and children.Data collection and analysisThree review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of the evidence using the GRADE approach. Our primary outcomes were all-cause mortality and serious adverse events; our secondary outcomes were health-related quality of life, pneumonia-related mortality, non-serious adverse events, and treatment failure. Our primary time point of interest was at maximum follow-up.Main resultsWe included four randomised clinical trials (84 participants). We assessed all trials as having high risk of bias. We did not conduct any meta-analyses, as the included trials did not compare similar antibiotic regimens. Each of the four trials assessed a different comparison, as follows: cefepime versus ceftazidime; linezolid versus vancomycin; meropenem versus cefotaxime; and ceftobiprole versus cephalosporin. Only one trial reported our primary outcomes of all-cause mortality and serious adverse events. Three trials reported our secondary outcome of treatment failure. Two trials primarily included community-acquired pneumonia and hospitalised children with bacterial infections, hence the children with hospital-acquired pneumonia constituted subgroups of the total sample sizes. Where outcomes were reported, the certainty of the evidence was very low for each of the comparisons. We are unable to draw meaningful conclusions from the numerical results. None of the included trials assessed health-related quality of life, pneumonia-related mortality, or non-serious adverse events.Authors' conclusionsThe relative beneficial and harmful effects of different antibiotic regimens remain unclear due to the very low certainty of the available evidence. The current evidence is insufficient to support any antibiotic regimen being superior to another. Randomised clinical trials assessing different antibiotic regimens for hospital-acquired pneumonia in children and neonates are warranted.

Dataset Information

Impact of Procalcitonin Monitoring on Duration of Antibiotics in Patients With Sepsis and/or Pneumonia in a Community Hospital Setting.

Publications

Impact of Procalcitonin Monitoring on Duration of Antibiotics in Patients With Sepsis and/or Pneumonia in a Community Hospital Setting.

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