Using Procalcitonin Measurements to Avoid Antibiotic Misuse in Patients with AECOPD

By the bioMérieux Connection Editors

The latest study to assess Procalcitonin (PCT) testing for antibiotic management demonstrates that PCT testing can significantly reduce the overuse of antibiotics in patients with chronic obstructive pulmonary disease (COPD) with no apparent adverse health effects to these patients. A team of researchers at the Allegheny General Hospital (AGH) in Pittsburgh retrospectively evaluated patients admitted to AGH with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Despite the fact that these patients do not benefit from antibiotics, in practice, they routinely are prescribed antibiotics.

Patients were chosen from those who were admitted with AECOPD and who had peak PCT concentration <0.25 μg/mL. Patients were broken into two groups: those who had antibiotic exposure of 24 hours or less and those who had exposure of 24 hours or more. There were 161 and 195 patients in each cohort, respectively.

The Allegheny team also evaluated patient outcomes based upon the duration of azithromycin therapy they received: 24 hours or less and 24 hours or more. The primary outcome was all-cause 30-day readmissions and the secondary outcomes were length of stay (LOS) and COPD-related 30-day readmissions.

“The primary finding of our study showed that for patients with a low PCT, administration of >24 hours of antibiotics was not associated with clinical benefit in regard to all-cause or COPD related 30-day hospital readmissions,” concluded the researchers in their paper, “Acute Exacerbations of Chronic Obstructive Pulmonary Disease With a Low Procalcitonin Concentration: Impact of Antibiotic Therapy,” published in Clinical Infectious Diseases.

The Allegheny team asserts that this study demonstrates that adherence to a PCT guidance protocol is associated with decreased total antibiotic exposure without an increase in adverse outcomes.

As for secondary outcomes, the study revealed no benefit in regard to azithromycin utilization in hospital readmissions, and those who received ≤24 hours of azithromycin had a shorter hospital LOS.

COPD patients are frequently admitted to the hospital and are exposed to inappropriate antibiotics, which is directly linked to the propagation of antimicrobial resistance.

The Allegheny team believes that, “This study adds significant data to help antimicrobial stewardship programs curb antibiotic misuse for patients with AECOPD by utilizing PCT as an objective biomarker to refrain from utilizing extended courses of antibiotics in clinically stable patients without elevated PCT concentrations.”

Opinions expressed in this article are not necessarily those of bioMérieux, Inc.

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