Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients

OBJECTIVES:. To examine the impact before and after adoption of a procalcitonin-based protocol to guide sepsis management has on antibiotic use, care costs, and outcomes of critically ill patients. DESIGN:. Before-after study. SETTING:. ICU of an academic tertiary care center. PATIENTS:. Adults over...

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Autores principales:	Jarva Chow, MD, MS, MPH, Talar W. Markossian, PhD, MPH, Fritzie S. Albarillo, MD, Elisabeth E. Donahey, PharmD, Kathleen L. Bobay, PhD, RN, FAAN
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/04971ef7eda04c06b5038d4a0b95fd79
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spelling	oai:doaj.org-article:04971ef7eda04c06b5038d4a0b95fd792021-11-25T07:56:59ZImpact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients2639-802810.1097/CCE.0000000000000571https://doaj.org/article/04971ef7eda04c06b5038d4a0b95fd792021-11-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000571https://doaj.org/toc/2639-8028OBJECTIVES:. To examine the impact before and after adoption of a procalcitonin-based protocol to guide sepsis management has on antibiotic use, care costs, and outcomes of critically ill patients. DESIGN:. Before-after study. SETTING:. ICU of an academic tertiary care center. PATIENTS:. Adults over 18 years old admitted to the ICU from January 1, 2017, to January 31, 2020. INTERVENTIONS:. In this before-after study, we compared the use of medications, outcomes, and overall cost before and after the introduction of a procalcitonin-based protocol for evaluation and treatment of sepsis. MEASUREMENTS AND MAIN RESULTS:. The final study cohort consisted of 1,793 patients admitted to the ICU, 776 patients pre-procalcitonin and 1,017 patients in the post-procalcitonin period. Patients were not different in the pre-procalcitonin adoption period compared with post-procalcitonin adoption with regard to gender, age (62.0 vs 62.6), race, or comorbidities. Patients admitted during the post-procalcitonin adoption period were less likely to receive the examined broad-spectrum antibiotics (odds ratio, –0.58; CI, –0.99 to –0.17; p < 0.01) than patients during the pre-procalcitonin adoption period. The odds of inhospital death did not differ after procalcitonin adoption when compared with before (0.87; CI, 0.70–1.09; p = 0.234). Total charges for each admission were significantly less in the post-procalcitonin adoption period $3,834.99 compared with pre-procalcitonin adoption $4,429.47 (p < 0.05). Patients post-procalcitonin adoption incurred $1,127.18 per patient less in total charges (–1,127.18; CI, –2,014.74 to –239.62; p = 0.013) after controlling for relevant factors. CONCLUSIONS:. In critically ill patients in a large U.S. tertiary care hospital, the adoption of a procalcitonin-based protocol for evaluation and treatment of sepsis may be associated with decreased antibiotic use and significant cost savings, with no change in mortality.Jarva Chow, MD, MS, MPHTalar W. Markossian, PhD, MPHFritzie S. Albarillo, MDElisabeth E. Donahey, PharmDKathleen L. Bobay, PhD, RN, FAANWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 11, p e0571 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Jarva Chow, MD, MS, MPH Talar W. Markossian, PhD, MPH Fritzie S. Albarillo, MD Elisabeth E. Donahey, PharmD Kathleen L. Bobay, PhD, RN, FAAN Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients
description	OBJECTIVES:. To examine the impact before and after adoption of a procalcitonin-based protocol to guide sepsis management has on antibiotic use, care costs, and outcomes of critically ill patients. DESIGN:. Before-after study. SETTING:. ICU of an academic tertiary care center. PATIENTS:. Adults over 18 years old admitted to the ICU from January 1, 2017, to January 31, 2020. INTERVENTIONS:. In this before-after study, we compared the use of medications, outcomes, and overall cost before and after the introduction of a procalcitonin-based protocol for evaluation and treatment of sepsis. MEASUREMENTS AND MAIN RESULTS:. The final study cohort consisted of 1,793 patients admitted to the ICU, 776 patients pre-procalcitonin and 1,017 patients in the post-procalcitonin period. Patients were not different in the pre-procalcitonin adoption period compared with post-procalcitonin adoption with regard to gender, age (62.0 vs 62.6), race, or comorbidities. Patients admitted during the post-procalcitonin adoption period were less likely to receive the examined broad-spectrum antibiotics (odds ratio, –0.58; CI, –0.99 to –0.17; p < 0.01) than patients during the pre-procalcitonin adoption period. The odds of inhospital death did not differ after procalcitonin adoption when compared with before (0.87; CI, 0.70–1.09; p = 0.234). Total charges for each admission were significantly less in the post-procalcitonin adoption period $3,834.99 compared with pre-procalcitonin adoption $4,429.47 (p < 0.05). Patients post-procalcitonin adoption incurred $1,127.18 per patient less in total charges (–1,127.18; CI, –2,014.74 to –239.62; p = 0.013) after controlling for relevant factors. CONCLUSIONS:. In critically ill patients in a large U.S. tertiary care hospital, the adoption of a procalcitonin-based protocol for evaluation and treatment of sepsis may be associated with decreased antibiotic use and significant cost savings, with no change in mortality.
format	article
author	Jarva Chow, MD, MS, MPH Talar W. Markossian, PhD, MPH Fritzie S. Albarillo, MD Elisabeth E. Donahey, PharmD Kathleen L. Bobay, PhD, RN, FAAN
author_facet	Jarva Chow, MD, MS, MPH Talar W. Markossian, PhD, MPH Fritzie S. Albarillo, MD Elisabeth E. Donahey, PharmD Kathleen L. Bobay, PhD, RN, FAAN
author_sort	Jarva Chow, MD, MS, MPH
title	Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients
title_short	Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients
title_full	Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients
title_fullStr	Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients
title_full_unstemmed	Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients
title_sort	impact of a procalcitonin-based protocol on antibiotic exposure and costs in critically ill patients
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/04971ef7eda04c06b5038d4a0b95fd79
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Impact of a Procalcitonin-Based Protocol on Antibiotic Exposure and Costs in Critically Ill Patients

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