Introduction of a PCT-based algorithm to guide antibiotic prescription in COPD exacerbation.
OBJECTIVE
Prescribing antibiotics for COPD exacerbations is not easy. Procalcitonin (PCT) is a useful biomarker that helps reduce the rate of antibiotic therapies. However, its proper cut-off levels are often unknown. We aimed to assess the impact of a PCT-based algorithm to guide antibiotic therapy prescription in COPD exacerbations.


METHODS
We conducted an observational, retrospective, and before/after study. We reviewed physician practices regarding PCT test and antibiotic therapy prescription to all patients hospitalized for COPD exacerbation. We then analyzed the rate of antibiotic prescriptions and the number of PCT tests prescribed before and after the introduction of a protocol validated by previous high-power studies. The primary endpoint was the rate of antibiotic prescriptions.


RESULTS
A total of 124 patients before protocol and 121 patients after protocol were included. Antibiotic prescriptions decreased by 41% after protocol introduction (59% vs. 35%, P<0.001), with no increase in morbidity and mortality at Day 30. Compliance with protocol was complete in 60% of cases and partial (no PCT guidance to discontinue antibiotics) in 8% of cases. Both antibiotic duration (8.3 days vs. 8.7 days) and length of hospital stay (8.5 days vs. 8.3 days, P=0.78) did not change.


CONCLUSIONS
Hospital physicians are already using PCT-based algorithm to guide antibiotic prescription in COPD exacerbations. Disseminating information on the appropriate PCT cut-off level to use to decide whether or not to initiate antibiotics is effective. Its proper use should be clarified to reduce antibiotic prescriptions to these overexposed patients.
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service des urgences, SMUR et SAMU 974, 97400 Saint-Denis, Reunion. Electronic address: jeanne.picart@gmail.com.
J
J
Picart
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service de maladies infectieuses, 97400 Saint-Denis, Reunion.
M P
MP
Moiton
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service de réanimation polyvalente, 97400 Saint-Denis, Reunion.
B-A
BA
Gaüzère
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service de pneumologie, 97400 Saint-Denis, Reunion.
V
V
Gazaille
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service des urgences, SMUR et SAMU 974, 97400 Saint-Denis, Reunion.
X
X
Combes
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service de médecine polyvalente, 97400 Saint-Denis, Reunion.
S
S
DiBernardo
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D018450:Disease Progression; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004635:Emergency Medicine; D005260:Female; D005602:France; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D007396:Internship and Residency; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002116:Calcitonin
Antibiothérapie; Antibiotic therapy; BPCO; COPD; Exacerbation; Procalcitonin; Procalcitonine