Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Rm 5R218, Salt Lake City, UT, 84132, USA.
Intern Emerg Med. 2021 Apr;16(3):677-686. doi: 10.1007/s11739-020-02618-3. Epub 2021 Jan 16.
Lower respiratory tract infections (LRTIs) due to bacterial pneumonia are common among hospitalized patients and are frequently treated with antibiotics. Viral illnesses and exacerbations of heart failure or COPD may present with symptoms mimicking a LRTI, resulting in unnecessary antibiotic utilization. Procalcitonin testing may be useful in these clinical scenarios. We attempted to assess the utility of procalcitonin testing versus not testing, and positive versus negative results among hospitalized patients with suspected LRTI. We performed a retrospective cohort study using multivariable analysis comparing clinical outcomes of patients with and without procalcitonin testing. Patients were 18 years or older, hospitalized for pneumonia, heart failure, COPD, or a viral respiratory illness between October 2014 and October 2015 (n = 2353). All patients received at least one dose of antibiotics. Major outcomes were duration of antibiotic therapy, length of hospital stay, C. difficile testing and infections, and normalized total direct costs. Procalcitonin testing occurred in 14.0% of patients and pneumonia (70.6%) was the most common diagnosis. After covariate adjustments, mean length of stay (5.61 vs. 6.67 days, p < 0.001) and duration of antibiotics (3.95 vs. 4.47 days, p < 0.001) were shorter among tested patients. Fewer 30-day readmissions (OR 0.62, 95% CI 0.40-0.95) were observed, and total direct healthcare costs were 34% lower (0.66, 95% CI 0.58-0.74) among tested patients. Negative procalcitonin results were associated with further reductions in some outcomes. In conclusion, procalcitonin testing among hospitalized patients with suspected LRTI is associated with reductions in antibiotic duration, length of stay, 30-day readmission, and healthcare costs.
下呼吸道感染（LRTIs）由于细菌性肺炎是常见的住院患者，并经常用抗生素治疗。病毒疾病和心力衰竭或 COPD 的恶化可能出现症状类似于 LRTI，导致不必要的抗生素利用。降钙素原检测可能在这些临床情况下有用。我们试图评估降钙素原检测与不检测、阳性与阴性结果在疑似 LRTI 的住院患者中的作用。我们进行了一项回顾性队列研究，使用多变量分析比较了有和没有降钙素原检测的患者的临床结局。患者年龄在 18 岁或以上，因肺炎、心力衰竭、COPD 或病毒性呼吸道疾病住院，时间为 2014 年 10 月至 2015 年 10 月（n=2353）。所有患者均接受了至少一剂抗生素。主要结局是抗生素治疗的持续时间、住院时间、艰难梭菌检测和感染以及归一化的总直接成本。降钙素原检测发生在 14.0%的患者中，最常见的诊断是肺炎（70.6%）。在调整协变量后，检测组的平均住院时间（5.61 天与 6.67 天，p<0.001）和抗生素使用时间（3.95 天与 4.47 天，p<0.001）更短。30 天内再入院率较低（OR 0.62，95%CI 0.40-0.95），检测组的直接医疗保健总费用降低 34%（0.66，95%CI 0.58-0.74）。降钙素原阴性结果与某些结局的进一步改善相关。总之，降钙素原检测在疑似 LRTI 的住院患者中与抗生素使用时间、住院时间、30 天内再入院率和医疗保健成本的降低有关。
