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

Jarva Chow; Talar W Markossian; Fritzie S Albarillo; Elisabeth E Donahey; Kathleen L Bobay

doi:10.1097/CCE.0000000000000571

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

Crit Care Explor. 2021 Nov 9;3(11):e0571. doi: 10.1097/CCE.0000000000000571. eCollection 2021 Nov.

Authors

Jarva Chow¹, Talar W Markossian², Fritzie S Albarillo³, Elisabeth E Donahey³, Kathleen L Bobay⁴

Affiliations

¹ Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
² Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL.
³ Loyola University Medical Center, Maywood, IL.
⁴ Parkinson School of Health Sciences and Public Health, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL.

Abstract

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.

Keywords: antimicrobial stewardship; cost; critical illness; outcomes; procalcitonin; sepsis.