Procalcitonin for sepsis management: Implementation within an antimicrobial stewardship program

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Clinical Microbiology

Background:

• Procalcitonin (PCT)-based algorithms can reduce antimicrobial use and improve survival in sepsis.
• Translating PCT algorithms into successful clinical practice has been challenging.
• Antimicrobial Stewardship Team (AST) involvement may enhance PCT algorithm implementation.

Purpose of the Study:

• To evaluate the impact of an AST-supported procalcitonin (PCT) algorithm on antibacterial therapy in intensive care unit (ICU) sepsis patients.
• To assess if AST involvement improves adherence to PCT-guided antibiotic protocols.
• To determine the effect of AST-supported PCT algorithms on antibiotic utilization and patient outcomes.

Main Methods:

• A pre-post intervention study design was used, comparing a standard PCT algorithm period (SPAP) with an AST-supported PCT algorithm period (ASPAP).
• Adult sepsis patients admitted to the ICU were included in both cohorts.
• The primary outcome was adherence to the PCT algorithm, with secondary outcomes including antibiotic duration, length of stay, readmission, and mortality.

Main Results:

• The AST-supported PCT algorithm period (ASPAP) showed significantly higher rates of baseline PCT assessment (90% vs 57%) and follow-up PCT measurement (76% vs 23%) compared to the standard period (SPAP).
• Antibiotic discontinuation per the PCT algorithm occurred more frequently in the ASPAP cohort (44% vs 7%).
• Patients in the ASPAP cohort received a shorter total duration of antibiotics (5 days vs 7 days; P = 0.02), with no significant differences in length of stay or 30-day mortality.

Conclusions:

• Implementation of a PCT algorithm facilitated by an AST significantly decreased the total duration of antibiotic use in ICU sepsis patients.
• The AST-supported PCT algorithm approach improved adherence to antibiotic guidelines.
• This strategy achieved reduced antibiotic exposure without compromising patient safety, as evidenced by no significant changes in mortality or length of stay.