Ammar Abdalla A, Lam Simon W, Duggal Abhijit, Neuner Elizabeth A, Bass Stephanie N, Guzman Jorge A, Wang Xiao-Feng, Han Xiaozhen, Bauer Seth R
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Pharmacotherapy. 2017 Feb;37(2):177-186. doi: 10.1002/phar.1887. Epub 2017 Feb 3.
To describe compliance with antibiotic recommendations based on a previously published procalcitonin (PCT)-guided algorithm in clinical practice, to compare PCT algorithm compliance rates between PCT assays ordered in the antibiotic initiation setting (PCT concentration measured less than 24 hours after antibiotic initiation or before antibiotic initiation) with those in the antibiotic continuation setting (PCT concentration measured 24 hours or more after antibiotic initiation), and to evaluate patient- and PCT-related factors independently associated with algorithm compliance in patients in the medical intensive care unit (MICU).
Single-center retrospective cohort study.
Large MICU in a tertiary care academic medical center.
A total of 527 adults admitted to the MICU unit over a 2-year period (November 1, 2011-October 31, 2013) who had a total of 957 PCT assays performed. PCT assays whose results were determined in the MICU were allocated retrospectively to either the initiation setting cohort or the continuation setting cohort based on timing of the PCT assay.
Each PCT assay was treated as a separate episode. Antibiotic regimens were compared between the 24-hour periods before and after the results of each PCT assay and evaluated against an algorithm to determine compliance. Clinical, laboratory, PCT-related, and microbiologic variables were assessed during the 24-hour period after the PCT assay results to determine their influence on PCT algorithm compliance. A larger proportion of PCT episodes occurred in the initiation setting (540 [56.4%]) than in the continuation setting (417 [43.5%]). Overall, compliance with PCT algorithm recommendations was low (48.5%) and not significantly different between the initiation setting and the continuation setting (49.1% vs 47.7%, p=0.678). No patient-related or PCT-related factors were independently associated with PCT algorithm compliance on multivariable logistic regression.
Compliance with PCT algorithm antibiotic recommendations in both the initiation and continuation settings was lower than that reported in published randomized studies. No factors were independently associated with PCT algorithm compliance. Institutions using PCT assays to guide antibiotic use should assess compliance with algorithm antibiotic recommendations. Inclusion of a formalized antimicrobial stewardship program along with a PCT-guided algorithm is highly recommended.
描述在临床实践中基于先前发表的降钙素原（PCT）指导算法对抗生素建议的依从性，比较在抗生素起始阶段（抗生素起始后24小时内或抗生素起始前测量的PCT浓度）与抗生素持续阶段（抗生素起始后24小时或更长时间测量的PCT浓度）所进行的PCT检测之间的PCT算法依从率，并评估与医学重症监护病房（MICU）患者的算法依从性独立相关的患者和PCT相关因素。
单中心回顾性队列研究。
一家三级医疗学术中心的大型MICU。
在2年期间（2011年11月1日至2013年10月31日）共527名入住MICU的成年人，共进行了957次PCT检测。在MICU确定结果的PCT检测根据PCT检测时间回顾性地分配到起始阶段队列或持续阶段队列。
每次PCT检测被视为一个单独的事件。在每次PCT检测结果前后的24小时内比较抗生素治疗方案，并根据一种算法进行评估以确定依从性。在PCT检测结果后的24小时内评估临床、实验室、PCT相关和微生物学变量，以确定它们对PCT算法依从性的影响。与持续阶段（417次[43.5%]）相比，起始阶段发生的PCT事件比例更高（540次[56.4%]）。总体而言，对PCT算法建议的依从性较低（48.5%），起始阶段和持续阶段之间无显著差异（分别为49.1%和47.7%，p = 0.678）。在多变量逻辑回归中，没有患者相关或PCT相关因素与PCT算法依从性独立相关。
在起始和持续阶段，对PCT算法抗生素建议的依从性低于已发表的随机研究报告的依从性。没有因素与PCT算法依从性独立相关。使用PCT检测来指导抗生素使用的机构应评估对算法抗生素建议的依从性。强烈建议纳入正式的抗菌药物管理计划以及PCT指导算法。
