Experience during the first year of procalcitonin implementation: a precautionary tale for smaller facilities

• Published in: Infection control and hospital epidemiology 2018-09, Vol.39 (9), p.1142-1143
• Main Author: Cole, Jennifer L
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Antibiotics; Antimicrobial Stewardship - methods; Cost control; Drug Monitoring - economics; Drug Monitoring - methods; Drug Monitoring - statistics & numerical data; Education; Emergency medical care; Epidemiology; FDA approval; Feedback; France; Hospitals; Humans; Infectious diseases; Intervention; Nursing; Pharmacy; Prescription Drug Overuse - prevention & control; Procalcitonin - blood; Respiratory tract; Sepsis
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2018.161

To the Editor—In the ongoing national debate regarding widespread implementation of procalcitonin (PCT) testing in antimicrobial stewardship programs to decrease antibiotic exposure, a consistent theme is the lack of unequivocal data that positive endpoints seen in clinical trials will hold up in nonstudy settings. While the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America offer a weak recommendation for PCT use in antimicrobial stewardship programs, they go on to say that facilities should determine whether this intervention is the best use of time and resources.1 While PCT utilization is more widespread in Europe, providers in the United States may have different prescribing patterns and may be more resistant to protocolization.2 Additionally, the added value of PCT monitoring in clinically obvious cases has been questioned as a high-cost intervention with low efficacy in routine practice.3 The recent publication of the procalcitonin-guided use of antibiotics for lower respiratory tract infection (ProACT) study notably illustrated that this intervention did not result in decreased antibiotic utilization in 14 US hospitals despite a relatively high compliance rate.4 The approval of PCT by the Food and Drug Administration (FDA) for starting and stopping antibiotics in lower respiratory tract infections, stopping antibiotics in sepsis, and predicting sepsis mortality comes from randomized controlled trials in large tertiary-care centers. [...]there was no cost savings in antibiotic purchasing: $306,173 before versus $315,303 after (difference, +$9,103). [...]135 recorded interventions related to PCT during the study period, mostly for de-escalating or discontinuing antibiotic therapy (acceptance rate not recorded).