Category: Professional Posters
Purpose: Procalcitonin is a serum biomarker of bacterial infection that is approved by the Federal Drug Administration to guide initiation and cessation of antibiotics in lower respiratory tract infections and cessation of antibiotics in sepsis. Appropriate and timely antibiotic administration is crucial in improving healthcare outcomes in patients with infections, but inappropriate antibiotic prescribing can contribute to antimicrobial resistance, adverse medication side effects, and Clostridium difficile infections. This purpose of this study was to evaluate the implementation of hospital-developed guidelines for the use of procalcitonin by assessing the utilization of procalcitonin diagnostic testing by clinicians and adherence to hospital-developed guidelines.
Methods: The institutional review board approved this retrospective quality improvement study. All patients enrolled in the study were admitted, had a procalcitonin serum test collected during the month of June 2018, and a suspected lower respiratory tract infection or sepsis. A retrospective review of Cerner electronic medical record data was performed to compile a list of patients with a serum procalcitonin lab value in June 2018. An electronic medical record review was then conducted for the compiled list of patients to assess for adherence to hospital guidelines for utilization of procalcitonin in antibiotic initiation and de-escalation. For all instances of deviation from the algorithm, investigators attempted to clarify clinical decision-making involved.
Results: The electronic medical record review was conducted for 50 patients admitted with serum procalcitonin values in June 2018. Of the patients with a known or suspected lower respiratory tract infection, 67% were initiated on antibiotics if the procalcitonin level was >0.25 as recommended by hospital guidelines. Of the 33% who were not initiated on antibiotics, 89% had clinical documentation on why antibiotics were deferred, such as not meeting quick sequential organ failure assessment (QSOFA) and systemic inflammatory response syndrome criteria (SIRS). 26% of patients were initiated on antibiotics despite having a procalcitonin value less than or equal to 0.25. Some documented reasons for this deviation from the guidelines include positive microbiology studies and meeting QSOFA and SIRS criteria. A follow up procalcitonin level was not collected in 41% of patients with a suspected lower respiratory tract infection. Of patients with known or suspected sepsis, 23% of patients that had a procalcitonin less than or equal to 0.5 had antibiotics discontinued. Follow up procalcitonin levels were not collected in 38.46% of patients.
Conclusion: Overall, providers are following the evidence based algorithms when deciding on whether to initiate antibiotics in suspected lower respiratory tract infections and when to discontinue antibiotics in suspected sepsis. When the algorithms are not adhered to, clinicians often provided documentation of the patient-specific clinical factors that led to the deviations. However, serial procalcitonin levels were not consistently drawn. By understanding how the procalcitonin diagnostic test is currently being utilized, investigators hope to create targeted educational interventions for clinicians to address knowledge gaps and encourage evidence-based patient care.