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An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: a feasibility study
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Accepted version
Date
2019-07-19
Authors
O'Riordan, Frank
Shiely, Frances
Byrne, Stephen
O'Brien, Deirdre
Palmer, B.
Dahly, Darren L.
O'Connor, Terence M.
Curran, David R.
Fleming, Aoife
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press
Published Version
Abstract
Background: Diagnostic uncertainty and a high prevalence of viral infections present unique challenges for antimicrobial prescribing for respiratory tract infections (RTIs). Procalcitonin (PCT) has been shown to support prescribing decisions and reduce antimicrobial use safely in patients with RTIs, but recent study results have been variable. Methods: We conducted a feasibility study of the introduction of PCT testing in patients admitted to hospital with a lower RTI to determine if PCT testing is an effective and worthwhile intervention to introduce to support the existing antimicrobial stewardship (AMS) programme and safely decrease antimicrobial prescribing in patients admitted with RTIs. Results: A total of 79 patients were randomized to the intervention PCT-guided treatment group and 40 patients to the standard care respiratory control group. The addition of PCT testing led to a significant decrease in duration of antimicrobial prescriptions (mean 6.8 versus 8.9 days, P"0.012) and decreased length of hospital stay (median 7 versus 8 days, P"0.009) between the PCT and respiratory control group. PCT did not demonstrate a significant reduction in antimicrobial consumption when measured as DDDs and days of therapy. Conclusions: PCT testing had a positive effect on antimicrobial prescribing during this feasibility study. The successful implementation of PCT testing in a randomized controlled trial requires an ongoing comprehensive education programme, greater integration into the AMS programme and delivery of PCT results in a timely manner. This feasibility study has shown that a larger randomized controlled trial would be beneficial to further explore the positive aspects of these findings.
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Keywords
Respiratory tract infections , Antimicrobials , Prescribing behavior , Procalcitonin
Citation
O’Riordan, F., Shiely, F., Byrne, S., O’Brien, D., Palmer, B., Dahly, D., O’Connor, T. M., Curran, D. and Fleming, A. (2019) 'An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: a feasibility study', Journal of Antimicrobial Chemotherapy, 74(11), pp. 3352-3361. doi: 10.1093/jac/dkz313
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Copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. This is a pre-copyedited, author-produced PDF of an article accepted for publication in Journal of Antimicrobial Chemotherapy following peer review. The version of record is available online at: https://academic.oup.com/jac/article/74/11/3352/5536342