Rachel Keilman
Orlando Health - Arnold Palmer Hospital for Children
Longwood, Florida
Disclosure information not submitted.
Alejandro Jordan-Villegas, MD
Pediatric Infectious Disease Physician
Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
Mallory Muller, PharmD, MBA, BCPPS
Clinical Pharmacist
Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
Bee Ben Khallouq
Biostatistician
Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
William Patten, MD
Pediatric Intensivist
Orlando Health - Arnold Palmer Hospital for Children, United States
Disclosure information not submitted.
Title: Procalcitonin-Guided Antibiotic Stewardship Decreases Antibiotics for Respiratory Infections in PICU
Introduction: Up to 80% of pediatric intensive care unit (PICU) patients receive antibiotics. Prolonged use can lead to patient harm and increased antibiotic resistance. Procalcitonin (PCT) is elevated in bacterial infections with higher specificity than C-reactive protein or white blood cell count. The goal of our study was to decrease total antibiotic days by implementing a PCT-guided antibiotic stewardship protocol.
Methods: Quality improvement project with a retrospective cohort chart review followed by a prospective cohort study of antibiotic use in a tertiary care children’s hospital PICU and Intermediate Care Unit. The study population included patients with suspected bacterial respiratory infections (uncomplicated/complicated pneumonia (PNA), tracheitis, ventilator-associated pneumonia (VAP)) who received antibiotics. Our protocol was based on prior adult and pediatric literature. It consisted of obtaining PCT levels on antibiotic Day 0, Day 1 and then every other day. If PCT < 0.25ng/ml, stopping antibiotics was strongly encouraged; if PCT decreased by >80% of peak or was 0.25 to 0.5ng/ml, stopping antibiotics was encouraged; if PCT decreased by < 80% of peak and PCT >0.5ng/ml, continuing antibiotics was encouraged; if PCT increased from peak and PCT >0.5ng/ml, changing antibiotics was encouraged. The primary outcome was total antibiotic days.
Results: In total, 53 patients met inclusion criteria (34 pre-protocol, 19 post-protocol). The post-protocol group and pre-protocol group were comparable regarding gender (58% male vs 76%, respectively, p = 0.14), but was older (11.5yo vs. 4.1yo, p = 0.05). In the post-protocol group, 68% of patients had PNA, 26% tracheitis, and 5% VAP; in the pre-protocol group, 12% of patients had PNA and 88% of patients tracheitis. Post-protocol versus pre-protocol total antibiotic days was a median of 5.3d (IQR 4.0-7.0d) versus 9.2d (8.0-11.1d) respectively (p < 0.001), a difference of 3.9d. Zero patients failed treatment post-protocol; 1 failed treatment pre-protocol.
Conclusions: In our study, PCT-guided antibiotic stewardship decreased total antibiotic days. This effect was despite having a higher proportion of pneumonia patients in our post-protocol group. PCT-guided antibiotic stewardship in pediatric critical care units can safely decrease total antibiotic days without leading to therapy failure.