title: Use of procalcitonin (PCT) to guide discontinuation of antibiotic use in an unspecified sepsis is an antimicrobial stewardship program (ASP).
abstract: Clinicians have used procalcitonin (PCT) (biomarker to differentiate bacterial from non-bacterial sepsis) to guide use of antibiotics in patients. As the data for utility of PCT to discontinue antibiotics in an antimicrobial stewardship program (ASP) are lacking, we aim to describe the outcomes of patients in whom PCT was used to discontinue antibiotics under our ASP. An antimicrobial stewardship (AS) team intervened to discontinue antibiotics in patients with persistent fever or leucocytosis, source of sepsis unknown or negative bacteriological cultures, who had completed an adequate course of antibiotic therapy and had a PCT of <0.5 μg/L. Main outcomes evaluated were 14-day re-infection, 30-day mortality and readmission. Antibiotic therapy was discontinued in 42 patients in 1 year. Unknown source of sepsis was found in 38% of the patients (including possible malignant fever) and culture-negative pneumonia was found in 21%. Two patients died of advanced cancer. One patient decided for comfort care and died one week later. One patient died due to a second episode of pneumonia 37 days after first PCT test. Six patients were readmitted within 30 days due to non-infectious causes. Three patients were readmitted due to culture-negative pneumonia. None had a 14-day re-infection. PCT used to discontinue antibiotics under our ASP did not compromise patients' outcome.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Blk 8 Level 2, Singapore, 169608, Singapore.
authors.forename: Y X
authors.initials: YX
authors.lastname: Liew
authors.forename: M P
authors.initials: MP
authors.lastname: Chlebicki
authors.forename: W
authors.initials: W
authors.lastname: Lee
authors.forename: L Y
authors.initials: LY
authors.lastname: Hsu
authors.forename: A L
authors.initials: AL
authors.lastname: Kwa
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000302:isolation & purification; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004358:Drug Therapy / Q000592:standards*; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007964:Leukocytosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D008297:Male; D011498:Protein Precursors / Q000097:blood*; D012008:Recurrence; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide