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Procalcitonin Trends in the Treatment of Suspected Bacterial Infection

Shah, Shilpa
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532808

Abstract Details

2014, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Introduction and Objective: Infection is a leading cause of death in children. However, clinicians at the bedside still cannot quickly and reliably detect bacterial infection, leading to antibiotic overuse, a modifiable contributor to antibiotic resistance. Biomarkers offer the potential for both the early detection of bacterial infection and the ability to track effective antibiotic treatment. One such biomarker, procalcitonin (PCT), has been demonstrated to safely reduce antibiotic prescription in critically ill adults when used to guide antibiotic initiation and duration. In the current study, we determined if simulation of a similar algorithm in critically ill children would predict a reduction in antibiotic prescription. Methods: We conducted a prospective, observational, repeated measures, cohort study in patients less than 18 years of age with suspected infection admitted to the pediatric intensive care unit (PICU) between June 2013 and March 2014. We obtained serial PCT measurements on all study subjects while receiving antibiotics. Clinicians were blinded to the PCT measurements, and all decisions regarding antibiotic therapy were at the discretion of the clinical team. The predicted antibiotic duration was determined by retrospectively applying a PCT guided algorithm of antibiotic prescription. The primary outcome was the paired difference in prescribed (as determined by the clinical team) vs. predicted antibiotic days (as determined by the simulated PCT guided algorithm). Additional analyses were performed for diagnostic accuracy of PCT. Results: The current report presents the findings in the first 40 consecutive subjects enrolled in the study. Subjects had a median age of 5 years (IQR 2.75, 12.25) with a median PICU length of stay of 3 days (IQR 1, 6). The receiver operating characteristic for initial PCT level had an area under the curve (AUC) of 0.76 for clinically defined bacterial infection and an AUC of 0.82 for infection defined by a positive bacterial culture. Twenty-eight patients (75%) would have received a median of 4.5 fewer antibiotic days based on the use of our simulated procalcitonin guided algorithm. These patients received a median of 7.5 antibiotic days (IQR 2.8, 13.3). Twelve patients (25%) would have received more antibiotic days based on the simulated model. These patients received a median of only 2 antibiotic days (IQR 1.75, 6). None of these patients had adverse consequence of untreated or undertreated infection. Using the multiple imputation model for missing data, the patients overall would have had a mean reduction of 4.7 days of antibiotic prescription (95% CI 2.8, 6.6, p<0.001). Conclusion: Procalcitonin had a moderate diagnostic accuracy for bacterial infection in this cohort. Simulating a procalcitonin guided algorithm in critically ill children with suspected infection in combination with a predictive model demonstrates a significant potential for reducing antibiotic days. A randomized controlled trial of a procalcitonin guided algorithm for antibiotic guidance in the critically ill child with suspected infection is warranted to determine the safety of such a method.
Erin Nicole Haynes, Dr. P.H. (Committee Chair)
Lin Fei, Ph.D. (Committee Member)
Derek S Wheeler, M.D. (Committee Member)
24 p.
Surgery
infection; pediatrics; biomarkers; antibiotics

Recommended Citations

Citations

  • Shah, S. (2014). Procalcitonin Trends in the Treatment of Suspected Bacterial Infection [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532808

    APA Style (7th edition)

  • Shah, Shilpa. Procalcitonin Trends in the Treatment of Suspected Bacterial Infection. 2014. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532808.

    MLA Style (8th edition)

  • Shah, Shilpa. "Procalcitonin Trends in the Treatment of Suspected Bacterial Infection." Master's thesis, University of Cincinnati, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532808

    Chicago Manual of Style (17th edition)

ucin1396532808
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This open access ETD is published by University of Cincinnati and OhioLINK.