title: Effect of introducing procalcitonin on antimicrobial therapy duration in patients with sepsis and/or pneumonia in the intensive care unit.
abstract: BACKGROUND
  Utilizing procalcitonin (PCT) levels to limit antimicrobial overuse would be beneficial from a humanistic and economic perspective.
  
  
  OBJECTIVE
  To assess whether introducing PCT at a teaching hospital reduced antimicrobial exposure in critically ill patients.
  
  
  METHODS
  Patients wereadmitted to the intensive care unit (ICU) for >72 hours with sepsis and/or pneumonia. PCT levels were drawn on admission to the ICU or with new suspected infection, with at least 1 PCT level being drawn at least 48 hours later. Patients were matched in a 1:1 fashion to historical patients on age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, gender, and primary diagnosis. The primary outcome was duration of initial antimicrobial exposure defined as days from initiation of antimicrobial therapy to the intentional discontinuation of therapy by the physician. Secondary end points included length of stay, readmission to the hospital, and relapse of infection.
  
  
  RESULTS
  There were 50 patients in the PCT group and 50 patients in the historical group. The initial duration of antimicrobials was 10 (±4.9) days compared with 13.3 (±7.2), which was statistically significant (P = .0238). The duration of stay in the hospital (13.5 compared with 17.8 days; P = .0299), readmission to the hospital (9 compared with 17; P = .055), and relapse of infection (3 compared with 11; P = .02) were seen less in the PCT group compared with controls.
  
  
  CONCLUSIONS
  Introducing PCT levels resulted in a shorter duration of initial antimicrobial therapy and was not associated with adverse treatment outcomes.
authors: Summa Health System, Akron City Hospital, Akron, OH, USA.
authors: Bryan M
authors: BM
authors: Bishop
authors: John J
authors: JJ
authors: Bon
authors: Tamara L
authors: TL
authors: Trienski
authors: Timothy R
authors: TR
authors: Pasquale
authors: Bradley R
authors: BR
authors: Martin
authors: Thomas M
authors: TM
authors: File
mesh_terms: D018806:APACHE; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002116:Calcitonin / Q000008:administration & dosage*; D015740:Calcitonin Gene-Related Peptide; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011014:Pneumonia / Q000188:drug therapy*; D011498:Protein Precursors / Q000008:administration & dosage*; D012008:Recurrence; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D000890:Anti-Infective Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: antibiotic consumption; bacterial pneumonia; intensive care unit patients; procalcitonin; sepsis