The Role of Procalcitonin as an Antimicrobial Stewardship Tool in Patients Hospitalized with Seasonal Influenza

Background: Up to 60% of the antibiotics prescribed to patients hospitalized with seasonal influenza are unnecessary. Procalcitonin (PCT) has the potential as an antimicrobial stewardship program (ASP) tool because it can differentiate between viral and bacterial etiology. We aimed to explore the role of PCT as an ASP tool in hospitalized seasonal influenza patients. Methods: We prospectively included 116 adults with seasonal influenza from two influenza seasons, 2018-2020. All data was obtained from a single clinical setting and analyzed by descriptive statistics and regression models. Results: In regression analyses, we found a positive association of PCT with 30 days mortality and the amount of antibiotics used. Influenza diagnosis was associated with less antibiotic use if the PCT value was low. Patients with a low initial PCT (<0.25 mu g/L) had fewer hospital and intensive care unit (ICU) days and fewer positive chest X-rays. PCT had a negative predictive value of 94% for ICU care stay, 98% for 30 days mortality, and 88% for bacterial coinfection. Conclusion: PCT can be a safe rule-out test for bacterial coinfection. Routine PCT use in seasonal influenza patients with an uncertain clinical picture, and rapid influenza PCR testing, may be efficient as ASP tools.

Automated summary

The unnecessary prescription of antibiotics in hospitalized seasonal influenza patients can be reduced by using procalcitonin (PCT) as an antimicrobial stewardship program (ASP) tool. The study found that higher PCT levels were associated with increased mortality and antibiotic usage. In patients diagnosed with influenza, lower PCT levels were associated with reduced antibiotic usage, shorter hospital and ICU stays, and fewer positive chest X-rays. The study suggests that PCT can be a safe rule-out test for bacterial coinfection and recommends the routine use of PCT and rapid influenza PCR testing as ASP tools in seasonal influenza patients with uncertain clinical presentations.