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Impact of Procalcitonin Guidance with an Educational Program on Management of Adults Hospitalized with Pneumonia.
Am J Med. 2017 Sep 22;:
Authors: Walsh TL, DiSilvio BE, Hammer C, Beg M, Vishwanathan S, Speredelozzi D, Moffa MA, Hu K, Abdulmassih R, Makadia JT, Sandhu R, Naddour M, Chan-Tompkins NH, Trienski TL, Watson C, Obringer TJ, Kuzyck J, Bremmer DN
Abstract
BACKGROUND: Community-acquired pneumonia and healthcare-associated pneumonia are often treated with prolonged antibiotic therapy. Procalcitonin (PCT) has effectively and safely reduced antibiotic use for pneumonia in controlled studies. However, limited data exists regarding PCT guidance in real-world settings for management of pneumonia.
METHODS: A retrospective, pre-intervention/post-intervention study was conducted to compare management for patients admitted with pneumonia before and after implementation of PCT guidance at two teaching hospitals in Pittsburgh, Pennsylvania. The pre-intervention period was March 1, 2014 through October 31, 2014, and the post-intervention period was March, 1 2015 through October 31, 2015.
RESULTS: A total of 152 and 232 patients were included in the pre-intervention and post-intervention cohorts, respectively. When compared to the pre-intervention group, mean duration of therapy decreased (9.9 vs 6.0 days; P < 0.001). More patients received an appropriate duration of 7 days or less (26.9% vs 66.4%; P < 0.001). Additionally, mean hospital length of stay decreased in the post-intervention group (4.9 vs 3.5 days; P = 0.006). Pneumonia-related 30-day readmission rates (7.2% vs 4.3%; P = 0.26) were unaffected. In the post-intervention group, patients with PCT levels < 0.25µg/L received shorter mean duration of therapy compared to patients with levels > 0.25µg/L (4.6 vs 8.0 days; P < 0.001) as well as reduced hospital length of stay (3.2 vs 3.9 days; P = 0.02).
CONCLUSIONS: In this real-world study, PCT guidance led to shorter durations of total antibiotic therapy and abridged inpatient length of stay without affecting hospital readmissions.
PMID: 28947168 [PubMed - as supplied by publisher]