BMC Infectious Diseases | |
Impact of adherence to procalcitonin antibiotic prescribing guideline recommendations for low procalcitonin levels on antibiotic use | |
Research | |
Michael J. Fine1  Elizabeth Gimbel2  Donald M. Yealy3  Jonathan G. Yabes4  Chung-Chou H. Chang4  Brian E. Malley5  David T. Huang6  Derek C. Angus7  | |
[1] Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA;Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA;The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh, Pittsburgh, PA, USA;Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh, Pittsburgh, PA, USA;Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA;The MACRO (Multidisciplinary Acute Care Research Organization) Center, University of Pittsburgh, Pittsburgh, PA, USA;University of Pittsburgh, 606B Scaife Hall, 3550 Terrace Street, 15261, Pittsburgh, PA, USA;The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh, Pittsburgh, PA, USA;Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;The MACRO (Multidisciplinary Acute Care Research Organization) Center, University of Pittsburgh, Pittsburgh, PA, USA; | |
关键词: Procalcitonin; Antibiotic; Guideline adherence; | |
DOI : 10.1186/s12879-022-07923-0 | |
received in 2022-06-11, accepted in 2022-12-05, 发布年份 2022 | |
来源: Springer | |
【 摘 要 】
BackgroundThe Procalcitonin Antibiotic Consensus Trial (ProACT) found provision of a procalcitonin antibiotic prescribing guideline to hospital-based clinicians did not reduce antibiotic use. Possible reasons include clinician reluctance to follow the guideline, with an observed 64.8% adherence rate. In this study we sought to determine the threshold adherence rate for reduction in antibiotic use, and to explore opportunities to increase adherence.MethodsThis study is a retrospective analysis of ProACT data. ProACT randomized 1656 patients presenting to 14 U.S. hospitals with suspected lower respiratory tract infection to usual care or provision of procalcitonin assay results and an antibiotic prescribing guideline to the treating clinicians. We simulated varying adherence to guideline recommendations for low procalcitonin levels and determined which threshold adherence rate could have resulted in rejection of the null hypothesis of no difference between groups at alpha = 0.05. We also performed sensitivity analyses within specific clinical settings and grouped patients initially prescribed antibiotics despite low procalcitonin into low, medium, and high risk of illness severity or bacterial infection.ResultsOur primary outcome was number of antibiotic-days by day 30 using an intention-to-treat approach and a null hypothesis of no difference in antibiotic use. We determined that an 84% adherence rate in the hospital setting (emergency department and inpatient) for low procalcitonin could have allowed rejection of the null hypothesis (3.7 vs 4.3 antibiotic-days, p = 0.048). The threshold adherence rate was 76% for continued guideline adherence after discharge. Even 100% adherence in the emergency department alone failed to reduce antibiotic-days. Of the 218 patients prescribed antibiotics in the emergency department despite low procalcitonin, 153 (70.2%) were categorized as low or medium risk.ConclusionsHigh adherence in the hospital setting to a procalcitonin antibiotic prescribing guideline is necessary to reduce antibiotic use in suspected lower respiratory tract infection. Continued guideline adherence after discharge and withholding of antibiotics in low and medium risk patients with low procalcitonin may offer impactful potential opportunities for antibiotic reduction.Trial registration Procalcitonin Antibiotic Consensus Trial (ProACT), ClinicalTrials.gov Identifier: NCT02130986. First posted May 6, 2014.
【 授权许可】
CC BY
© The Author(s) 2023
【 预 览 】
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