Impact of Low Procalcitonin Results on Antibiotic Administration in Hospitalized Patients at a Tertiary Care Center

被引：3
作者：
Brennan M.B. [1 ]
Osterby K. [2 ]
Schulz L. [3 ]
Lepak A.J. [1 ]
机构：
[1] Department of Medicine, University of Wisconsin, Madison, WI
[2] Center for Clinical Knowledge Management, University of Wisconsin Hospital and Clinics, Madison, WI
[3] Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI
来源：
Infectious Diseases and Therapy | 2016年 / 5卷 / 2期
关键词：
Antibiotic stewardship; Behavioral sciences; Discordance; Procalcitonin;
D O I：
10.1007/s40121-016-0114-1
中图分类号：
学科分类号：
摘要：
Procalcitonin is a sensitive and specific marker of bacterial infection; low results allow clinicians to safely de-escalate antibiotics. This retrospective cohort study aimed to determine the effect of low procalcitonin results on withholding, discontinuing, or de-escalating antibiotics in hospitalized patients at a tertiary care center. Antibiotics were initiated or continued without de-escalation in 55% of patients with low procalcitonin results. Among patients with low procalcitonin results, the primary service, but not measures of patient complexity, disease severity, or underlying disease process (lower respiratory tract infection evaluation versus systemic inflammatory response syndrome/possible sepsis) was associated with initiation or continued broad-spectrum antibiotic use. Provider-level factors may be an important variable in the initiation or continued use of broad-spectrum antibiotics for patients with low procalcitonin levels. © 2016, The Author(s).
引用
收藏
页码：185 / 191
页数：6
相关论文
共 14 条
  • [1] Becker K.L., Nylen E.S., White J.C., Muller B., Snider R.H., Clinical review 167: procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors, J Clin Endocrinol Metab, 89, pp. 1512-1525, (2004)
  • [2] Wacker C., Prkno A., Brunkhorst F.M., Schlattmann P., Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis, Lancet Infect Dis, 13, pp. 426-435, (2013)
  • [3] Schuetz P., Chiappa V., Briel M., Greenwald J.L., Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms, Arch Intern Med, 171, pp. 1322-1331, (2011)
  • [4] Soni N.J., Samson D.J., Galaydick J.L., Vats V., Pitrak D.L., Aronson N., Procalcitonin-guided antibiotic therapy. Comparative effectiveness review no. 78. AHRQ publication no. 12(13)-EHC124-EF, (2012)
  • [5] Schuetz P., Muller B., Christ-Crain M., Stolz D., Tamm M., Bouadma L., Luyt C.E., Wolff M., Chastre J., Tubach F., Kristoffersen K.B., Burkhardt O., Welte T., Schroeder S., Nobre V., Wei L., Bhatnagar N., Bucher H.C., Briel M., Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections, Evid Based Child Health, 8, pp. 1297-1371, (2013)
  • [6] Albrich W.C., Dusemund F., Bucher B., Meyer S., Thomann R., Kuhn F., Bassetti S., Sprenger M., Bachli E., Sigrist T., Schwietert M., Amin D., Hausfater P., Carre E., Gaillat J., Schuetz P., Regez K., Bossart R., Schild U., Mueller B., Pro R.S.T., Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in “real life”: an international, multicenter poststudy survey (ProREAL), Arch Intern Med, 172, pp. 715-722, (2012)
  • [7] Foushee J.A., Hope N.H., Grace E.E., Applying biomarkers to clinical practice: a guide for utilizing procalcitonin assays, J Antimicrob Chemother, 67, pp. 2560-2569, (2012)
  • [8] Deyo R.A., Cherkin D.C., Ciol M.A., Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases, J Clin Epidemiol, 45, pp. 613-619, (1992)
  • [9] Bayoumi A.M., Redelmeier D.A., Decision analysis with cumulative prospect theory, Med Decis Making, 20, pp. 404-412, (2000)
  • [10] Persell S.D., Friedberg M.W., Meeker D., Linder J.A., Fox C.R., Goldstein N.J., Shah P.D., Knight T.K., Doctor J.N., Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]—study protocol and baseline practice and provider characteristics, BMC Infect Dis, 13, (2013)
12