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Ann Am Thorac Soc. 2017 Dec;14(12):1779-1785. doi: 10.1513/AnnalsATS.201702-133OC.

Hospital Procalcitonin Testing and Antibiotic Treatment of Patients Admitted for Chronic Obstructive Pulmonary Disease Exacerbation.

Author information

1
1 Institute for Healthcare Delivery and Population Science, and.
2
2 Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
3
4 Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
4
5 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
5
6 Division of Infectious Disease, Baystate Medical Center, Springfield, Massachusetts.
6
7 School of Public Health and Health Sciences, University of Massachusetts--Amherst, Amherst, Massachusetts.
7
8 Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio.
8
9 Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois-Chicago, Chicago, Illinois; and.
9
10 The Pulmonary Center, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.

Abstract

RATIONALE:

Randomized trials suggest that assessment of serum procalcitonin (PCT) levels can be used to safely limit antibiotic use among patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD).

OBJECTIVES:

To determine the impact of PCT testing on antibiotic treatment of patients hospitalized for exacerbations of COPD in routine practice.

METHODS:

We conducted a series of cross-sectional and longitudinal multivariable analyses using data from 2009 to 2011 and 2013 to 2014 from a sample of 505 U.S. hospitals.

RESULTS:

Of 203,177 patients hospitalized for COPD exacerbation in 2013 to 2014, nearly 9 out of 10 were treated with antibiotics. Hospital PCT testing rates ranged from 0 to 83%. In cross-sectional analysis, there was a weak negative association between the rate of PCT testing and risk-adjusted rates of antibiotic initiation (Spearman correlation, -0.12; P = 0.005); each 10-point increase in the percentage of patients undergoing PCT testing was associated with a 0.7% decline in risk-adjusted antibiotic use (P = 0.001). There was no association between hospital rates of PCT testing and duration of antibiotic treatment. In a longitudinal analysis, comparing treatment patterns in 2009 to 2011 and 2013 to 2014, we did not observe a significant difference in the change in antibiotic treatment rates or duration of therapy between hospitals that had adopted PCT testing compared with those that had not.

CONCLUSIONS:

As currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations. Implementation research is necessary to translate the promising outcomes from PCT testing observed in randomized trials into clinical practice.

KEYWORDS:

chronic obstructive pulmonary disease; health care outcome assessment; health services research

PMID:
28795838
PMCID:
PMC5711260
DOI:
10.1513/AnnalsATS.201702-133OC
[Indexed for MEDLINE]
Free PMC Article

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