A retrospective analysis of the impact of a hospital pharmacist-led procalcitonin protocol

2021 ◽  
Author(s):  
Carrolyn K Cowey ◽  
Erica Wilson
Keyword(s):  
Respiratory Tract Infections ◽  
Primary Outcome ◽  
Medical Center ◽  
Hospital Pharmacist ◽  
Antimicrobial Treatment ◽  
Lower Respiratory Tract Infections ◽  
Before And After ◽  
Center Hospital ◽  
Tract Infections ◽  
The Impact

Abstract Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Procalcitonin is a precursor hormone to calcitonin that increases in response to systemic inflammation, especially of bacterial origin, and is otherwise undetectable in healthy states. Studies have shown that following effective antimicrobial treatment, procalcitonin levels steadily decline. To be utilized however, procalcitonin determinations must be ordered at specific times during a patient’s antimicrobial treatment. A retrospective medication-use evaluation of patients was performed at Medical Center Hospital and showed that in 70% of patients, initial procalcitonin levels were ordered inappropriately and procalcitonin levels were trended inconsistently during antibiotic treatment. Methods A pharmacist-led procalcitonin protocol was developed and presented to medical staff committees for approval. Data was collected from patients presenting with suspected or confirmed sepsis or lower respiratory tract infections for whom procalcitonin levels were utilized. Patient outcomes before and after protocol implementation were compared. Results A total of 400 patients were included in the study. The primary outcome of appropriate ordering of initial procalcitonin levels was improved in the postprotocol group relative to the preprotocol group (28% of patients [n = 56] vs 72% of patients [n = 144]; P < 0.001). Patients in the postprotocol group had a procalcitonin level checked at discontinuation more frequently (8% [n = 16] vs 37% [n = 74], P < 0.001) and had a higher rate of appropriate discontinuation of antibiotics (12% [n = 21] vs 46% [n = 77]; P < 0.001). The postprotocol group also had fewer mean days of antibiotic therapy (9.17 vs 6.01; P < 0.001). Conclusion Studies have shown the usefulness of procalcitonin levels for antimicrobial stewardship, but for procalcitonin testing to be properly utilized it must be ordered at the correct times during the patient’s therapy. The implementation of a hospital-wide pharmacist-led protocol resulted in an increase in appropriate ordering of baseline procalcitonin levels.

scholarly journals 1039. Forty-eight-hour Antibiotic Time-out: Impact on Antibiotic Duration and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S365-S366
Author(s):  
Natasha N Pettit ◽  
Palak Bhagat ◽  
Cynthia T Nguyen ◽  
Victoria J L Konold ◽  
Madan Kumar ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Inpatient Setting ◽  
Core Element ◽  
Time Out ◽  
Before And After ◽  
Control And Prevention ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Abstract Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g., temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures.

A Pseudo-Outbreak ofAureobasidiumSpecies Lower Respiratory Tract Infections Caused by Reuse of Single-Use Stopcocks During Bronchoscopy

2000 ◽  
Vol 21 (7) ◽  
pp. 470-472 ◽  
Author(s):  
Stephen J. Wilson ◽  
Richard J. Everts ◽  
Kathryn B. Kirkland ◽  
Daniel J. Sexton
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Medical Center ◽  
Lower Respiratory Tract Infections ◽  
Outbreak Period ◽  
Single Use ◽  
True Infection ◽  
Tract Infections ◽  
And Function

Objective:To investigate and control an apparent outbreak of lower respiratory tract infections due to Aureobasidium species.Design:Outbreak investigation.Setting:University-affiliated medical center.Patients:Nine patients who underwent bronchoscopy between June and August 1998.Results:Ten bronchoalveolar lavage (BAL) fluid cultures from nine patients grewAureobasidiumspecies during the outbreak period; whereas, respiratory specimens from only two patients grewAureobasidiumspecies during the preceding 6 years. No patient was judged to have true infection due toAureobasidiumspecies either before or after bronchoscopy. Nine of the 10 bronchoscopies that yieldedAureobasidiumspecies were performed in the outpatient bronchoscopy suite. TheAureobasidiumisolates were not associated with any one bronchoscope. Observation of bronchoscopy procedure revealed that plastic stopcocks labeled for single use were reused on different patients during BAL. There was no record of how many times each stopcock was being reused. After each use, the stopcocks were placed in an automated disinfection machine designed for bronchoscopes. Culture of the stopcocks after they had been “disinfected” yielded a heavy growth ofAureobasidiumspecies, while culture of fluid from the automated disinfection machine was negative. Reuse of the stopcocks was halted, and, during the following 6-month period,Aureobasidiumspecies were not isolated from any BAL specimen.Conclusions:Reuse of medical equipment labeled for single use is potentially hazardous, especially if no quality control system is in place to monitor sterility and function after reprocessing.

scholarly journals Practical Comparison of the BioFire FilmArray Pneumonia Panel to Routine Diagnostic Methods and Potential Impact on Antimicrobial Stewardship in Adult Hospitalized Patients with Lower Respiratory Tract Infections

2020 ◽  
Vol 58 (7) ◽  
Author(s):  
Blake W. Buchan ◽  
Sam Windham ◽  
Joan-Miquel Balada-Llasat ◽  
Amy Leber ◽  
Amanda Harrington ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Diagnostic Methods ◽  
Lower Respiratory Tract Infections ◽  
Percent Agreement ◽  
Tract Infections ◽  
Hospital Acquired ◽  
The Impact ◽  
Antibiotic Agents

ABSTRACT Lower respiratory tract infections, including hospital-acquired and ventilator-associated pneumonia, are common in hospitalized patient populations. Standard methods frequently fail to identify the infectious etiology due to the polymicrobial nature of respiratory specimens and the necessity of ordering specific tests to identify viral agents. The potential severity of these infections combined with a failure to clearly identify the causative pathogen results in administration of empirical antibiotic agents based on clinical presentation and other risk factors. We examined the impact of the multiplexed, semiquantitative BioFire FilmArray Pneumonia panel (PN panel) test on laboratory reporting for 259 adult inpatients submitting bronchoalveolar lavage (BAL) specimens for laboratory analysis. The PN panel demonstrated a combined 96.2% positive percent agreement (PPA) and 98.1% negative percent agreement (NPA) for the qualitative identification of 15 bacterial targets compared to routine bacterial culture. Semiquantitative values reported by the PN panel were frequently higher than values reported by culture, resulting in semiquantitative agreement (within the same log10 value) of 43.6% between the PN panel and culture; however, all bacterial targets reported as >105 CFU/ml in culture were reported as ≥105 genomic copies/ml by the PN panel. Viral targets were identified by the PN panel in 17.7% of specimens tested, of which 39.1% were detected in conjunction with a bacterial target. A review of patient medical records, including clinically prescribed antibiotics, revealed the potential for antibiotic adjustment in 70.7% of patients based on the PN panel result, including discontinuation or de-escalation in 48.2% of patients, resulting in an average savings of 6.2 antibiotic days/patient.

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