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Impact of a Pharmacist-Managed Procalcitonin Program on COVID-19 Respiratory Tract Infection Outcomes and Health Care
Andrew J Fratoni1, Abigail K Kois1, Jessica L Colmerauer2
1Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA.
Insights
A pharmacist-managed procalcitonin (PCT) monitoring program for COVID-19 patients did not reduce antibiotic use or healthcare resource utilization. This study found no significant differences in antibiotic duration or patient outcomes after program implementation.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Pharmacology
Background:
- Patients hospitalized with COVID-19 often receive empiric antibiotic coverage.
- Procalcitonin (PCT) is an FDA-approved biomarker to guide antibiotic use in respiratory infections.
- Antimicrobial stewardship programs aim to optimize antibiotic prescribing.
Purpose of the Study:
- To evaluate the impact of a pharmacist-managed PCT monitoring program on antibiotic use in hospitalized COVID-19 patients.
- To assess the effect of PCT-guided antibiotic discontinuation on clinical outcomes and healthcare resource utilization.
- To determine adherence to PCT cutoffs for antibiotic therapy in a real-world setting.
Main Methods:
- Quasi-experimental, single-center, retrospective study of a prospective program.
- Inclusion of hospitalized patients positive for SARS-CoV-2.
- Pharmacist review of antibiotic appropriateness using PCT values (≤0.25 ng/mL for discontinuation).
Main Results:
- No significant difference in the percentage of patients receiving >1 day of antibiotic therapy (23.5% vs 21.7%).
- No significant differences observed in hospital length of stay, 30-day readmission rates, or discharge disposition.
- Antibiotic prescribing rates within 72 hours of admission were similar between pre- and post-intervention cohorts (44.7% vs 42.7%).
Conclusions:
- Implementation of a pharmacist-managed PCT monitoring program did not significantly decrease antibiotic use in hospitalized COVID-19 patients.
- The program did not lead to significant changes in healthcare resource utilization or clinical outcomes.
- Findings suggest limited impact in settings where empiric antibiotics are not broadly used for COVID-19.
Abstract:
Patients hospitalized with coronavirus disease 2019 (COVID-19) often receive empiric antibiotic coverage. Procalcitonin (PCT) is a biomarker with Food and Drug Administration-approved guidance cutoffs for antibiotic use in lower respiratory tract infections. Herein we describe the implementation and impact of a pharmacist-managed PCT monitoring program in hospitalized patients with COVID-19. In this quasi-experimental, single-center, retrospective study of a prospective antimicrobial stewardship pharmacist-managed program, inpatients who were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction positive were reviewed during weekday working hours and evaluated for appropriateness of antibiotic treatment by utilizing the PCT biomarker. As needed, the infectious diseases pharmacist offered feedback around antibiotic discontinuation in patients with PCT values ≤0.25 ng/mL. Adherence to PCT cutoffs, clinical outcomes, and utilization of health care resources were quantified and compared with a time frame immediately preceding the program's implementation. A total of 772 patients hospitalized with COVID-19 were analyzed. The pre-intervention cohort was comprised of 519 patients, and 253 patients were included after program implementation. Antibiotics were prescribed within 72 hours of admission to 232 (44.7%) and 108 (42.7%) patients during the control and intervention phases, respectively. There was no difference in the primary outcome of percentage of patients who received >1 day of antibiotic therapy (23.5% vs 21.7%; P = .849) or in any secondary outcome including hospital length of stay, 30-day readmission rates, or discharge disposition. In a hospital where the majority of COVID-19 patients did not receive empiric antibiotics, the implementation of a pharmacist-managed PCT monitoring program did not significantly decrease antibiotic use or health care resource utilization.
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