Critical Care |

Procalcitonin Does Not Decrease Antibiotic Duration in an Antimicrobial Stewardship Driven MICU FREE TO VIEW

Anisha Arora; Luis Reyes; Kelly Echevarria; Antonio Anzueto; Jose Cadena; Elena Laserna; Oriol Sibila, MD; Marcos Restrepo, MS
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University of Texas Health Science Center at San Antonio, San Antonio, TX

Chest. 2014;146(4_MeetingAbstracts):215A. doi:10.1378/chest.1994904
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SESSION TITLE: ICU Infections Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Procalcitonin (PCT) has been shown to reduce duration of antibiotics in patients with lower respiratory tract infections and sepsis. However, there are limited data regarding implementation and clinical effectiveness studies using PCT in the Intensive Care Unit (ICU). Our aim was to assess thru a quality improvement project the impact of PCT in duration of antibiotic therapy among critically ill patients.

METHODS: A pre- and post- quality improvement (QI) implementation program was evaluated in a cohort of critically ill patients admitted to the MICU. The pre-QI implementation review included PCT tests performed from April 1, 2011 to June 30, 2011 (14 weeks). The QI intervention included an educational program, development and implementation of an algorithm for PCT utilization and post-clinical performance data. Post-QI implementation review included PCT samples collected from January 11, 2012 to February 16, 2012 (6 weeks). The primary outcomes were duration of antibiotics in the ICU and in the hospital setting. Chi-square and Students t-test were used to compare categorical and continuous variables, respectively.

RESULTS: We evaluated 32 patients in the pre-QI period and 42 in the post-QI period. There were no statistically significant differences regarding age, gender, and comorbid conditions between pre and post QI implementation programs. Primary outcomes data of ICU antibiotic use measured as a median (interquartile range - IQR) was 4.0 (2.0-7.7) in the pre-QI program vs. 3.0 (1.0-6.0) days in the post-QI program (p=.2). In addition the hospital antibiotic use was 7.4 (5.0-9.2) vs. 7.0 days (1.0-11.0) in the pre- and post- QI periods, respectively (p=.7).

CONCLUSIONS: PCT utilization did not shorten the duration of antibiotic use in a medical intensive care setting with an established antimicrobial stewardship program. Further studies should assess the antimicrobial duration before implementing the use of PCT to assist clinicians in the decision to stop antibiotic therapy.

CLINICAL IMPLICATIONS: Procalcitonin clinical effectiveness need to allow reduction of antibiotics use in the ICU when Antimicrobial Stewardship programs are already in place.

DISCLOSURE: The following authors have nothing to disclose: Anisha Arora, Luis Reyes, Kelly Echevarria, Antonio Anzueto, Jose Cadena, Elena Laserna, Oriol Sibila, Marcos Restrepo

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