Prevalence of Discordant Procalcitonin Use at an Academic Medical Center. Issue 6 (11th December 2021)

• Record Type: Journal Article
• Authors: Seymann, Gregory B; Bevins, Nicholas; Wu, Christina; Fitzgerald, Robert
• Is Part Of: American journal of clinical pathology. Volume 157:Issue 6(2022)
• Page Start: 890
• Page End: 898
• Publication Date: 2021-12-11
• Subjects: Procalcitonin -- Antibiotic stewardship -- High-value care; Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqab201
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: Despite multiple trials demonstrating that procalcitonin (PCT) is an effective tool for antibiotic stewardship, inconsistent application in real-world settings continues to fuel controversy regarding its clinical utility. We sought to determine rates of concordance between PCT results and antibiotic prescribing in hospitalized patients. Methods: We performed a retrospective review of all inpatient encounters at an academic tertiary care health system with a PCT result between February 2017 and October 2019. Concordant prescribing was defined as starting or continuing antibiotics following an elevated PCT (>0.5 ng/mL) finding and withholding or stopping antibiotics following a low PCT (< 0.1 ng/mL) finding. Results: Antibiotic prescribing decisions were discordant from the PCT level in 32.5% of our sample. Among patients not receiving antibiotics at the time of testing, 25.9% (430 of 1, 662) were prescribed antibiotics despite a low PCT result. Among patients already receiving antibiotics, treatment was continued despite a low PCT level in 80.4% (728 of 906) of cases. Enhanced decision support tools introduced during the study period had no impact on PCT use for antibiotic decisions. Conclusions: Overall concordance between PCT results and antibiotic use is relatively low in a real-world setting. The potential value of PCT for antibiotic stewardship may not be fully realized.