Impact of Pharmacist-Led Procalcitonin-Guided Antibiotic Therapy in Critically Ill Patients With Pneumonia

Abstract

Purpose: Procalcitonin (PCT) is a peptide that is released in response to bacterial infections. The 2016 Infectious Diseases Society of America pneumonia guidelines recommend PCT monitoring to help guide antibiotic discontinuation. Utilization of PCT is well described in the literature; however, there is a paucity of literature regarding pharmacists’ involvement for using PCT in antibiotic interventions. The objective of this study was to investigate the effect of pharmacist-led intervention with PCT-guided antibiotic therapy in critically ill patients with pneumonia. Methods: This was a pre-post study conducted at a 1368-bed community teaching hospital in the United States. A prospective cohort with pharmacist intervention utilizing PCT-algorithm guidance was compared with a retrospective historical cohort with standard therapy. Adult patients admitted to the intensive care unit (ICU) with pneumonia were included. The primary endpoint was duration of antibiotic therapy. Secondary endpoints included 28-day mortality, ICU and hospital length of stay, reinitiation of antibiotic therapy, and the incidence of Clostridium difficile infection. Results: From August 2016 to July 2017, 113 patients were screened in the PCT group and 123 patients in the standard therapy group. Of these, 37 patients were included in the PCT group and 37 patients in the standard therapy group. Baseline characteristics were similar between the 2 groups. The antibiotic duration of therapy was 6.3 days in the PCT group versus 9.7 days in the standard therapy group ( P < .001). There were no differences in secondary endpoints between the 2 groups. Conclusion: Clinical pharmacists’ intervention with PCT-guided antibiotic therapy led to a reduction in the duration of antibiotic therapy in critically ill patients with pneumonia without increasing complications.

Impact of Pharmacist-Directed Simplified Procalcitonin Algorithm on Antibiotic Therapy in Critically Ill Patients With Sepsis

“…Because we previously experienced success with a PCT algorithm in our institution in reducing antibiotic therapy for critically ill patients with pneumonia, simplification of the algorithm and expanding its use to sepsis helped with awareness and adherence among our critical care providers. 13 This study has several limitations. This was a singlecenter study with a small sample size.…”

“…12 Recently, our institution incorporated a PCT algorithm with pharmacists' interventions in patients with community-acquired pneumonia, and observed reduction in antibiotic duration of therapy. 13 This current study evaluated the impact of pharmacist recommendations utilizing a more simplified PCT algorithm on critically ill patients and expanded indications to sepsis or septic shock.…”

Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin

“…While data exist highlighting the utility of pharmacist-driven procalcitonin protocols, the impact of a clinical-decision support tool such as the pharmacist Daily Checklist embedded in an electronic health record has not been as well documented [18][19][20]. This project aims to validate the effectiveness of this clinical decision support tool following the conversion from ASP-driven interventions to clinical pharmacist-led stewardship.…”

Impacts of Pharmacy Intervention on Appropriateness of Antibiotics Use in Pneumonia Patients

“…A study indicated that 30-80% of antibiotic provision were not based on accurate indication, which can further increase bacterial resistance, treatment costs, morbidity, and mortality [11], [12]. Many other pharmacy intervention studies on the usage of wide range of antibiotics and varied purposes in the treatment of pneumonia patients have been undertaken elsewhere [10], [13], [14], [15]. Furthermore, efforts to avoid inappropriate use of antibiotics in all areas of the world are important to maximize clinical outcomes, minimize side effects, avoid toxicity, reduce treatment costs, and most importantly to reduce the global emergence of bacterial resistance [16].…”