Procalcitonin for sepsis management: Implementation within an antimicrobial stewardship program

Purpose Clinical trials of procalcitonin (PCT)-based algorithms for antibacterial therapy have shown a reduction in antimicrobial use and improved survival. Translation of PCT algorithms to clinical settings has often been unsuccessful. We hypothesized that appropriate utilization of PCT could be improved by implementing an antimicrobial stewardship team (AST) approach to PCT testing. Methods We completed a pre-post intervention evaluation of adult patients admitted to the intensive care unit with a diagnosis of sepsis. The standard PCT algorithm period (SPAP) cohort included patients enrolled before dedicated AST involvement. During the AST-supported PCT algorithm period (ASPAP), the AST reviewed and provided feedback for all appropriate patients. The primary outcome was adherence to the PCT algorithm. Results Thirty-five and 57 patients were evaluated in the SPAP and ASPAP cohorts, respectively. There were no differences in demographics or infection site between the groups. Baseline PCT assessment was ordered in a larger proportion of patients in the ASPAP cohort (90% vs 57%; P = 0.0006). Follow-up PCT measurement was performed in more patients in the ASPAP cohort (76% vs 23%; P < 0.0001). Antibiotics were discontinued per algorithm in more patients in the ASPAP cohort (25/57 [44%] vs 2/35 [7%]; P < 0.0001). Patients in the ASPAP cohort experienced a shorter total duration of antibiotics (5 vs 7 days; P = 0.02), with no significant difference in length of stay or 30-day readmission or mortality between the cohorts. Conclusion A PCT algorithm successfully implemented by an AST was associated with a significant decrease in total antibiotic days with no differences in mortality or length of stay.

Automated summary

The implementation of an antimicrobial stewardship team approach to procalcitonin (PCT) testing resulted in improved adherence to the PCT algorithm, increased PCT assessment and measurement, and more patients discontinuing antibiotics per algorithm. This intervention led to a significant decrease in total antibiotic days without impacting mortality or length of stay.