Diagnostic stewardship of procalcitonin testing by implementation of computer-based decision support.

Abstract

Introduction: Appropriate test utilization strategies are paramount in preventing the overuse of antibiotics, which can contribute to antimicrobial resistance. Biomarkers such as procalcitonin (PCT) are frequently ordered upon suspicion of infection, but current pneumonia and sepsis guidelines recommend against using PCT alone when initiating antibiotic therapy. The purpose of this study was to evaluate the effectiveness of standardized, guideline-based computerized decision support in curbing the inappropriate ordering of PCT testing.

Methods: This study was a retrospective, single-center cohort of hospitalized adult patients with at least 1 available PCT serum level over a 27-month period. Secondary outcomes included the total number of PCT orders, the number of days on antibiotics, and the appropriate antibiotic response rate based on the PCT result.

Results: A total of 300 patients met our inclusion criteria for this study. The rate of appropriate PCT ordering increased in the postimplementation group (2% vs 10%), with an increased rate of appropriate ordering in patients with community-acquired pneumonia (4.3% vs 18.4%) and no change in patients with sepsis (0% vs 3.3%). Overall, PCT orders dropped by 78% after implementation of decision support.

Discussion: This study demonstrated that the addition of guideline-based computerized clinical decision support increased the rate of diagnostic stewardship for PCT orders.