PURPOSE: The purpose was to determine whether a simplified procalcitonin (PCT) algorithm guided by pharmacist recommendations reduces antibiotic duration of therapy in critically ill patients with suspected sepsis. METHODS: This was a single-centered pre-post study conducted at a 1368-bed community teaching hospital in the United States. A prospective cohort with pharmacist intervention utilizing a simplified PCT algorithm was compared with a retrospective historical cohort with standard therapy. Adult patients admitted to the intensive care unit (ICU) with suspected sepsis who received intravenous antibiotics were included. A pharmacist recommended continuation or discontinuation of antibiotics based on the PCT level per our algorithm and full clinical assessment of the patient. Primary outcome was total duration of antibiotic therapy. Secondary outcomes were ICU and hospital length of stay (LOS), reinitiation of antibiotic therapy within 72 hours of discontinuation, and 28-day in-hospital mortality. RESULTS: From September 2017 to May 2018, 360 patients were screened for eligibility. Of these, 26 patients were included in the PCT group and 26 patients in the standard therapy group. Baseline characteristics were similar between groups. A significant difference in duration of antibiotic therapy was detected with a median of 9 days in the PCT group versus 12 days in the standard therapy group (P = .02). There were no significant differences in secondary endpoints of ICU and hospital LOS, reinitiation of antibiotics at 72 hours, or 28-day mortality. CONCLUSION: Use of a simplified PCT algorithm with pharmacist-guided recommendations significantly reduced the duration of antibiotic therapy in critically ill patients with sepsis.
PURPOSE: The purpose was to determine whether a simplified procalcitonin (PCT) algorithm guided by pharmacist recommendations reduces antibiotic duration of therapy in critically ill patients with suspected sepsis. METHODS: This was a single-centered pre-post study conducted at a 1368-bed community teaching hospital in the United States. A prospective cohort with pharmacist intervention utilizing a simplified PCT algorithm was compared with a retrospective historical cohort with standard therapy. Adult patients admitted to the intensive care unit (ICU) with suspected sepsis who received intravenous antibiotics were included. A pharmacist recommended continuation or discontinuation of antibiotics based on the PCT level per our algorithm and full clinical assessment of the patient. Primary outcome was total duration of antibiotic therapy. Secondary outcomes were ICU and hospital length of stay (LOS), reinitiation of antibiotic therapy within 72 hours of discontinuation, and 28-day in-hospital mortality. RESULTS: From September 2017 to May 2018, 360 patients were screened for eligibility. Of these, 26 patients were included in the PCT group and 26 patients in the standard therapy group. Baseline characteristics were similar between groups. A significant difference in duration of antibiotic therapy was detected with a median of 9 days in the PCT group versus 12 days in the standard therapy group (P = .02). There were no significant differences in secondary endpoints of ICU and hospital LOS, reinitiation of antibiotics at 72 hours, or 28-day mortality. CONCLUSION: Use of a simplified PCT algorithm with pharmacist-guided recommendations significantly reduced the duration of antibiotic therapy in critically ill patients with sepsis.
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Authors: Vandack Nobre; Stephan Harbarth; Jean-Daniel Graf; Peter Rohner; Jérôme Pugin Journal: Am J Respir Crit Care Med Date: 2007-12-20 Impact factor: 21.405
Authors: Evelien de Jong; Jos A van Oers; Albertus Beishuizen; Piet Vos; Wytze J Vermeijden; Lenneke E Haas; Bert G Loef; Tom Dormans; Gertrude C van Melsen; Yvette C Kluiters; Hans Kemperman; Maarten J van den Elsen; Jeroen A Schouten; Jörn O Streefkerk; Hans G Krabbe; Hans Kieft; Georg H Kluge; Veerle C van Dam; Joost van Pelt; Laura Bormans; Martine Bokelman Otten; Auke C Reidinga; Henrik Endeman; Jos W Twisk; Ewoudt M W van de Garde; Anne Marie G A de Smet; Jozef Kesecioglu; Armand R Girbes; Maarten W Nijsten; Dylan W de Lange Journal: Lancet Infect Dis Date: 2016-03-02 Impact factor: 25.071
Authors: S Schroeder; M Hochreiter; T Koehler; A-M Schweiger; B Bein; F S Keck; T von Spiegel Journal: Langenbecks Arch Surg Date: 2008-11-26 Impact factor: 3.445
Authors: Philipp Schuetz; Robert Birkhahn; Robert Sherwin; Alan E Jones; Adam Singer; Jeffrey A Kline; Michael S Runyon; Wesley H Self; D Mark Courtney; Richard M Nowak; David F Gaieski; Stefan Ebmeyer; Sascha Johannes; Jan C Wiemer; Andrej Schwabe; Nathan I Shapiro Journal: Crit Care Med Date: 2017-05 Impact factor: 7.598