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Use of a Procalcitonin-guided Antibiotic Treatment Algorithm in the Pediatric Intensive Care Unit

Sophie E Katz1, Jennifer Crook1,2, Jessica Gillon3

  • 1From the Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN.

The Pediatric Infectious Disease Journal
|November 12, 2020
PubMed

Insights

Procalcitonin testing did not reduce antibiotic use in critically ill children. However, this study demonstrated the feasibility of a procalcitonin-guided antibiotic treatment algorithm in the pediatric intensive care unit (PICU).

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease management
  • Clinical trial methodology

Background:

  • The effectiveness of procalcitonin testing in guiding antibiotic therapy within the pediatric intensive care unit (PICU) remains uncertain.
  • Antibiotic stewardship (AS) is crucial for optimizing antimicrobial use in pediatric intensive care settings.
  • Critically ill children often receive broad-spectrum antibiotics, necessitating strategies to reduce unnecessary exposure.

Purpose of the Study:

  • To evaluate the impact of a procalcitonin-guided antibiotic treatment algorithm, combined with AS, on antibiotic utilization in critically ill children.
  • To compare antibiotic days of therapy (DOT) between a procalcitonin-guided arm and a usual care arm in the PICU.
  • To assess the feasibility of implementing a procalcitonin-based algorithm within a pediatric intensive care environment.

Main Methods:

  • A single-center, pragmatic, randomized prospective clinical trial was conducted involving critically ill children receiving intravenous antibiotics.
  • Patients were assigned monthly to either a procalcitonin testing arm or a usual care arm.
  • The procalcitonin arm involved daily testing and AS interpretation, while both arms received routine AS audit and feedback.

Main Results:

  • No significant difference in median antibiotic DOT was observed between the procalcitonin arm (6.6 days) and the usual care arm (7.6 days) within the first 14 days (P=0.37).
  • The procalcitonin arm saw a higher number of antibiotic stewardship recommendations (54 vs. 37; P=0.03).
  • Adherence to algorithm-based antibiotic recommendations in the procalcitonin arm was high at 70%.

Conclusions:

  • The study found no significant reduction in antibiotic DOT using a procalcitonin-guided algorithm in the PICU.
  • While underpowered, the trial successfully demonstrated the feasibility of implementing a procalcitonin-guided antibiotic treatment algorithm with AS support in critically ill children.
  • Further research with larger sample sizes is warranted to confirm the clinical utility of procalcitonin in this population.
Abstract

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