Impact of serum procalcitonin on antibiotic stewardship in surgical high-dependency unit and intensive care unit settings

• Published in: Access microbiology Vol. 2; no. 2
• Main Authors: Zorzoli, Azul, Meney, Laura, Shone, John, Taylor, Aaron, Hilton-Christie, Sharon, Dorfmueller, Helge, Parcell, Benjamin
• Format: Journal Article
• Language: English
• Published: 01.02.2020
• DOI: 10.1099/acmi.fis2019.po0191
• ISSN: 2516-8290

Background Procalcitonin (PCT) testing is used as a biomarker for bacterial infection. We assessed the impact of using a PCT-guided algorithm in Ninewells hospital & Medical School (Dundee, Scotland, UK). Methods We conducted a retrospective analysis of the use of PCT-testing to evaluate the escalation or de-escalation of antibiotic therapy. For this, we analysed patients admitted to the intensive care unit (ICU) and surgical high dependency unit (SHDU) from November 2018 to April 2019. Results We analysed a dataset of 235 adult patients, 23% of which were at the hospital’s ICU and 77% at the SHDU. Within the ICU, 49% of admitted patients were already on antibacterial therapy, compared to 93% at SHDU. The PCT results influenced the prescription of antibiotics in 33% of total patients (89% and 16% of all ICU and SHDU patients, respectively). Escalation of the antimicrobial therapy was prescribed to 34% of ICU patients after PCT testing, compared to 20% of SHDU patients. Continuation of the previously-established antibacterial scheme was more pronounced in SHDU patients (43% against 23% ICU). In contrast, while discontinuation of the therapy was observed in similar levels on both units (27% SHDU, 28% ICU). Conclusion PCT has become a useful tool in antimicrobial stewardship. Its use aided the prescription of antibiotics in 33% of the overall total cases in ICU and SHDU. Further work should be carried out to assess its role in other clinical environments.