Procalcitonin-guided testing cuts antibiotic use by 29% in nursing facilities
The study reports a quality improvement initiative evaluating procalcitonin (PCT) testing to guide antibiotic therapy in a 304-bed skilled nursing facility. Over a 27-month period comprising baseline, intervention, and follow-up phases, PCT-guided decision-making reduced the monthly number of residents on antibiotics from 34 to 24, representing a 29% decrease. Days of therapy and antibiotic initiation rates fell by 35% and 22%, respectively, with sustained control chart metrics confirming intervention success. These findings demonstrate that integrating PCT into nursing facility workflows can serve as a practical laboratory tool for antibiotic stewardship and reduce unnecessary antimicrobial prescribing.
The original study
Procalcitonin Reduces Overuse of Antibiotics in Nursing Facility Residents: A Quality Improvement Initiative.
- Authors
- Gerges SM, Saidy E, Sansone GR
- Journal
- American journal of medical quality : the official journal of the American College of Medical Quality
- Type
- Journal Article
- PMID
- 42831538
Original abstract
Procalcitonin (PCT), a biomarker for bacterial infections, has been studied in different clinical settings, including primary care, emergency departments, and intensive care units. Much less in nursing facilities (NFs), where antibiotic use is usually excessive. The aim of this quality assurance performance improvement initiative was to determine the effectiveness and sustainability of PCT in reducing unnecessary antibiotics in a 304-bed skilled NF. The initiative consisted of: (1) a 9-month baseline as a reference point; (2) a 9-month intervention where eligible residents were tested for PCT to help guide and monitor their antibiotic treatments. During the intervention, the plan-do-study-act cycle was applied to gauge the initiative, and control charts were used to determine the intervention success; and (3) a 9-month follow-up to validate the PCT effectiveness. The control chart rule of ≥8 consecutive months below the chart centerline indicated that the PCT intervention was successful. Monthly number of residents on antibiotics decreased from 34 at baseline down to 24 at follow-up, an overall 29% reduction. Days of therapy and antibiotic starts decreased from 33.0 and 5.4 at baseline down to 21.6 and 4.2 at follow-up, an overall reduction of 35% and 22%, respectively. Thus, utilization of PCT as a tool of antibiotic stewardship was associated with a reduction in antibiotic overuse among residents in this skilled NF.