99 - Comparison of Procalcitonin Testing to a Targeted Audit-and Feedback Strategy on Prescribed Durations of Therapy for Community-Acquired Pneumonia

Background: The procalcitonin (PCT) assay is FDA-approved to help guide antimicrobial treatment of respiratory tract infections, however, conflicting data exist regarding its impact on shortening durations of therapy. The purpose of this study was to compare the impact of PCT to a targeted audit-and-feedback (TAF) strategy on prescribed antibiotic durations of therapy for community-acquired pneumonia (CAP).

Methods: A retrospective cohort study was conducted at two community teaching hospitals, one implementing PCT with routine audit-and-feedback and one implementing a TAF strategy recommending 5 days of therapy for uncomplicated CAP. The primary objective of this study was to compare the impact of PCT implementation to TAF implementation on durations of therapy prescribed for suspected CAP. Secondary objectives included comparing length of stay, 30-day readmission, mortality, and rates of Clostridioides difficile. Adult inpatients with an antibiotic ordered with an indication of pneumonia were eligible for inclusion. Those who were critically ill, immunocompromised, had concurrent infections, were made comfort care, discharged or expired within 48 hours were excluded.

Results: 311 patients were included (Pre-TAF n=80, Pre-PCT n=80, Post-TAF n=80, Post-PCT n=71). Average duration of therapy prescribed for CAP at baseline was similar between groups, Pre-TAF 7.0 days vs. Pre-PCT 7.8 days (p=0.1). After implementation of the respective interventions, there remained no difference in the average duration of therapy between groups, Post-TAF 5.5 days vs. Post-PCT 5.4 days (p=0.8). Both PCT and TAF strategies demonstrated significant improvement in prescribed durations for CAP between their respective Pre- and Post-intervention groups (p< 0.001 and p=0.002, respectively). The PCT protocol was followed 41% of the time in the Post-PCT group. There were no differences in readmission, mortality, or C. difficile between groups.

Conclusion: PCT and TAF were equally effective antimicrobial stewardship strategies in reducing total days of antibiotic therapy prescribed for CAP with no differences observed in patient outcomes.