Chockalingam Leela, Mee Thomas, Gardner Tiffany, Grimm Eric, Baduashvili Amiran
Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Internal Medicine Residency Program, University of Colorado School of Medicine, Aurora, CO, USA.
Antimicrob Steward Healthc Epidemiol. 2025 May 28;5(1):e119. doi: 10.1017/ash.2025.72. eCollection 2025.
It is unknown how providers are utilizing procalcitonin in the real world to make antibiotic prescribing decisions, and whether procalcitonin can limit harms related to antibiotic misuse. We examined how the probability of receiving antibiotics changed just below and above the pre-specified procalcitonin cut-points. We sought to understand whether providers interpret procalcitonin as a dichotomous or continuous diagnostic test.
Retrospective cohort study.
We included adult inpatients who had procalcitonin collected as part of routine care. Patients with procalcitonin collected more than 48 hours after the first antibiotic dose, those discharged from the emergency department, or those on an obstetrics service were excluded.
We used administrative data from the Health Data Compass database (2018-2019) at the University of Colorado Hospital to examine the correlation of pre-specified procalcitonin cut-points (0.1, 0.25, and 0.5 ng/mL) with the antibiotic treatment decisions using a regression discontinuity analysis (RDA), stratified by level of care. We constructed receiver operating characteristic (ROC) curves depicting the relationship between procalcitonin level and antibiotic prescribing. We performed sensitivity analyses by varying bandwidth for RDA.
The study included 4383 patients. A total of 68.9% received a full antibiotic course. RDA did not demonstrate any discontinuity at the pre-specified cut-points. However, sensitivity analyses showed a potential discontinuity at the 0.25 ng/mL cut-point in the ICU subgroup. The ROC curves were consistent with the RDA findings.
This study suggests that most clinicians in real-world settings interpret procalcitonin as a continuous diagnostic test when prescribing antibiotics.
目前尚不清楚医疗服务提供者在现实世界中如何利用降钙素原做出抗生素处方决策，以及降钙素原是否能减少与抗生素滥用相关的危害。我们研究了在预先设定的降钙素原切点上下，接受抗生素治疗的概率是如何变化的。我们试图了解医疗服务提供者是将降钙素原视为二分诊断试验还是连续诊断试验。
回顾性队列研究。
我们纳入了作为常规护理一部分采集了降钙素原的成年住院患者。排除首次使用抗生素剂量48小时后采集降钙素原的患者、从急诊科出院的患者或产科患者。
我们使用科罗拉多大学医院健康数据指南针数据库（2018 - 2019年）的管理数据，通过回归断点分析（RDA），按护理级别分层，研究预先设定的降钙素原切点（0.1、0.25和0.5 ng/mL）与抗生素治疗决策之间的相关性。我们构建了描绘降钙素原水平与抗生素处方之间关系的受试者工作特征（ROC）曲线。我们通过改变RDA的带宽进行敏感性分析。
该研究纳入了4383名患者。共有68.9%的患者接受了完整的抗生素疗程。RDA在预先设定的切点处未显示任何断点。然而，敏感性分析显示在ICU亚组中，0.25 ng/mL切点处存在潜在断点。ROC曲线与RDA结果一致。
本研究表明，在现实环境中，大多数临床医生在开具抗生素处方时将降钙素原视为连续诊断试验。
