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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Procalcitonin-guided protocol decreased the antibiotic use in paediatric patients with severe bronchiolitis

Carme Alejandre1, Mònica Balaguer1, Carmina Guitart1

  • 1Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Institut de Recerca H. Sant Joan de Déu, Barcelona, Spain.

Acta Paediatrica (Oslo, Norway : 1992)
|December 27, 2019
PubMed

Insights

A procalcitonin-guided protocol safely reduced antibiotic use in infants with severe bronchiolitis. This approach decreased antibiotic prescription rates and treatment duration without adverse events in pediatric intensive care.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Antibiotic Stewardship

Background:

  • Severe bronchiolitis in infants often leads to antibiotic use, even in the absence of bacterial infection.
  • Over-prescription of antibiotics contributes to antimicrobial resistance and adverse patient outcomes.
  • Procalcitonin (PCT) is a biomarker that can help differentiate bacterial from viral infections.

Purpose of the Study:

  • To evaluate the effectiveness and safety of a procalcitonin-guided protocol for reducing antibiotic consumption in infants hospitalized with severe bronchiolitis.
  • To assess the impact of PCT guidance on antibiotic prescription rates, duration of treatment, and patient safety.

Main Methods:

  • Prospective observational study comparing two cohorts of infants under one year with severe bronchiolitis admitted to a pediatric intensive care unit.
  • Cohort 1 (2010-2014): Standard care. Cohort 2 (2015-2017): Procalcitonin-guided protocol implementation.
  • Data collected included antibiotic use rates, stewardship decisions, treatment duration, and adverse events.

Main Results:

  • A total of 706 infants were included (340 before, 366 after protocol implementation).
  • Antibiotic use decreased significantly from 88.2% to 72.1% (P=.003) after implementing the PCT protocol.
  • Antibiotic stewardship decisions increased, and the average treatment duration shortened from 8.65 to 5.05 days (P=.023).

Conclusions:

  • Implementation of a procalcitonin-guided protocol is effective in reducing antibiotic use in infants with severe bronchiolitis.
  • This strategy appears safe, with no observed adverse outcomes related to the protocol.
  • PCT guidance represents a valuable tool for antibiotic stewardship in pediatric critical care settings.
Abstract

Keywords:
antibioticsbronchiolitisinvasive bacterial infectionprocalcitoninstewardship

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