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

摘要

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.