Assessing the use of Procalcitonin in Lower Respiratory Tract Infections in the Medical Intensive Care Unit

DJ Wallman, MD

Authors: Daniel Wallman, MD, Ryan Knodle, MD, Joan Savage, MD, Swetha Ramachadran, MD., Kim Ackerbaum, PharmD, Megan Feeney, PharmD., Shyam Patel, PharmD, Allan Walkey, MD, Tamar Barlam, MD

Background: Routine use of procalcitonin has not yet fully been taken up in everyday clinical practice; however, multiple studies have found the biomarker to be a useful clinical tool for aiding in antimicrobial stewardship interventions when used in the appropriate context. The IDSA has recommended that the procalcitonin should be measured in a serial fashion that best meets the institution’s needs in order to enhance antibiotic stewardship.

Objective: To identify and analyze baseline procalcitonin ordering practices on patients with a lower respiratory tract infection admitted to the BMC MICU.

Methods: All patients admitted to the BMC MICU with a suspected or confirmed diagnosis of a lower respiratory tract infection in whom a procalcitonin was ordered and were started on antibiotics from January 2019 to February 2019 were observed for the following metrics: 1) if and when a follow up procalcitonin was ordered, 2) the value of each procalcitonin obtained thereafter.

Results: 29 patients met inclusion criteria. 6 (20%) did not have a follow up PCT level and 5 of those had initial levels greater than 0.5 (a positive result). Of those who did have a follow up value obtained, 17 (73%) were measured within 24 hours of the initial level, 6 (26%) within 24-48 hours of the initial level and 2 (8%) were measured after 48 hours of the initial measurement. 

Conclusion: The current ordering practices for procalcitonin in the BMC MICU is not serialized and ordering practices are variable. Further study is undergoing in order to rectify this. 

4 comments

  1. DJ, very nice approach! Your findings are a great example of the challenges inherent in standardizing approaches to therapy!! Well-done! Dave

  2. Thanks for taking on this project, DJ. Really interesting to see how the use of pct matches up with guidelines. Getting pharmacy colleagues on board to help standardize seems like a nice approach!

  3. May be worth considering a formal pragmatic clinical trial in our MICUs comparing the impact of serial PCT measurements on Abx choice and clinical outcome in those with and those without serial measurements. David

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