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Am J Med. 2018 Feb;131(2):201.e1-201.e8. doi: 10.1016/j.amjmed.2017.08.039. Epub 2017 Sep 22.

Impact of Procalcitonin Guidance with an Educational Program on Management of Adults Hospitalized with Pneumonia.

Author information

1
Division of Infectious Diseases, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa; Division of Infectious Diseases, The Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh. Electronic address: thomas.walsh@ahn.org.
2
Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa.
3
Division of Infectious Diseases, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa; Division of Infectious Diseases, The Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh.
4
Department of Pharmacy, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa.
5
Center for Inclusion Health, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa.
6
Division of Pulmonary Medicine, The Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh.
7
Department of Microbiology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa.
8
Department of Pharmacy, The Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh.

Abstract

BACKGROUND:

Community-acquired pneumonia and healthcare-associated pneumonia are often treated with prolonged antibiotic therapy. Procalcitonin (PCT) has effectively and safely reduced antibiotic use for pneumonia in controlled studies. However, limited data exist regarding PCT guidance in real-world settings for management of pneumonia.

METHODS:

A retrospective, preintervention/postintervention study was conducted to compare management for patients admitted with pneumonia before and after implementation of PCT guidance at 2 teaching hospitals in Pittsburgh, Pennsylvania. The preintervention period was March 1, 2014 through October 31, 2014, and the postintervention period was March, 1 2015 through October 31, 2015.

RESULTS:

A total of 152 and 232 patients were included in the preintervention and postintervention cohorts, respectively. When compared with the preintervention group, mean duration of therapy decreased (9.9 vs 6.0 days; P < .001). More patients received an appropriate duration of 7 days or less (26.9% vs 66.4%; P < .001). Additionally, mean hospital length of stay decreased in the postintervention group (4.9 vs 3.5 days; P = .006). Pneumonia-related 30-day readmission rates (7.2% vs 4.3%; P = .26) were unaffected. In the postintervention group, patients with PCT levels <0.25 µg/L received shorter mean duration of therapy compared with patients with levels >0.25 µg/L (4.6 vs 8.0 days; P < .001), as well as reduced hospital length of stay (3.2 vs 3.9 days; P = .02).

CONCLUSIONS:

In this real-world study, PCT guidance led to shorter durations of total antibiotic therapy and abridged inpatient length of stay without affecting hospital readmissions.

KEYWORDS:

Community-acquired pneumonia; Healthcare-associated pneumonia; Procalcitonin

PMID:
28947168
DOI:
10.1016/j.amjmed.2017.08.039
[Indexed for MEDLINE]

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