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Chest Infections |

Review of Procalcitonin Utilization at McLeod Regional Medical Center

Vinod Jona, MD; Jenna Swindler*, PharmD; Cathy Stokes, MSN; Nanditha Rawalpally
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McLeod Regional Medical Center, Florence, SC


Chest. 2012;142(4_MeetingAbstracts):196A. doi:10.1378/chest.1388631
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Abstract

SESSION TYPE: ICU Infections Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Procalcitonin (PCT) is released in response to pro-inflammatory stimuli. Research has shown PCT is released in the bloodstream 2-6 hours after bacteria are present in the blood. PCT levels > 2 ng/mL are suggestive of sepsis. Measuring PCT serum levels can potentially help identify ICU patients at high risk of mortality due to sepsis or septic shock. PCT measurements may also decrease unnecessary antibiotic use. The purpose of this study was to review the effect of PCT testing implementation at our institution.

METHODS: This was a 30 day prospective chart review of patients on whom a PCT level was ordered. A clinical pharmacist collected patient data, which included ordering physician, infectious disease related diagnosis, antimicrobial therapy duration, readmission rate, and mortality. The appropriateness of antimicrobial continuation or discontinuation was assessed based on PCT level, microbiological data, radiological data, and clinical condition. The total number of PCT levels ordered and ordering service was also evaluated.

RESULTS: A total of 116 patients were evaluated and 135 levels were ordered. The most common diagnosis was sepsis or pneumonia. Intensivists most frequently utilized PCT testing. Patients were divided into 3 groups (low, moderate, high) based on their PCT level. Patients with elevated PCT levels most commonly were diagnosed with sepsis. Localized infections did not typically cause elevated PCT levels. There was a subset of patients with gram negative sepsis, which showed extreme elevations in PCT levels. Antibiotics were changed or continued appropriately in 98% of patients. Antibiotics were discontinued in 27.5% of patients resulting in lower duration of therapy. There was no effect on readmission or mortality.

CONCLUSIONS: The results from this review show trending of PCT levels influenced the discontinuation or escalation of antibiotic coverage, if the clinical condition warranted, without affecting readmission or mortality. Future objectives include analysis of gram negative infections, false negative rates, and the economic impact of PCT testing.

CLINICAL IMPLICATIONS: Trending of PCT levels can be used as guidance to continue, broaden, or decrease the usage of antibiotics.

DISCLOSURE: The following authors have nothing to disclose: Vinod Jona, Jenna Swindler, Cathy Stokes, Nanditha Rawalpally

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McLeod Regional Medical Center, Florence, SC

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