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Purpose: The correlation of serum procalcitonin (PCT) with the clinical course of bacterial infection has sparked interest in the utility of PCT-guided treatment algorithms for determining appropriate antibiotic duration. The purpose of this study is to evaluate our institution’s use of PCT-guided antibiotic discontinuation for safety, efficacy, and economic purposes.
Methods: This single-center, retrospective cohort study was approved by OhioHealth’s IRB and included all medical intensive care patients admitted to Grant Medical Center from March 2010 through September 2011. Patients were excluded if they were not on antibiotic therapy when the PCT was drawn, if death/discharge occurred before the PCT was reported, or if prolonged (>17-day) antibiotic courses were prescribed. Remaining patients were assigned to one of three study arms based on if and how PCT values correlated with antibiotic discontinuation during admission. Group 1 represented a control group (no PCT drawn during admission), and Groups 2 and 3 represented treatment arms differing based on if antibiotic discontinuation occurred against or in line with the currently-recommend PCT-guided algorithm. Primary outcomes included 28-day mortality and total antibiotic days, and nine secondary outcomes were also measured.
Results: 789 patients were included in the final analysis. The PCT groups may have been more clinically complicated than the control. While there was no significant difference in 28-day mortality between the three groups (p=0.200), the PCT groups saw significantly more total antibiotic days than the control (p<0.001) and poorer secondary outcomes.
Conclusion: While PCT-guided antibiotic discontinuation was associated with increased antibiotic use and worse secondary outcomes, its use may have mitigated mortality in a more complex patient population. PCT may therefore have some utility in determining antibiotic duration, though algorithmic use of this biomarker appears inadvisable and currently-recommended PCT cut-off values for critical patients should be reevaluated.