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Real-word utility of procalcitonin in patients hospitalized with community-acquired pneumonia: A matched cohort study

Published online by Cambridge University Press:  28 February 2025

Dan Ilges Open the ORCID record for Dan Ilges [Opens in a new window] ,
Dylan Kosaski Open the ORCID record for Dylan Kosaski [Opens in a new window] ,
Maria Teresa Seville Open the ORCID record for Maria Teresa Seville [Opens in a new window] ,
Alyssa K. McGary Open the ORCID record for Alyssa K. McGary [Opens in a new window] ,
John C. O’Horo Open the ORCID record for John C. O’Horo [Opens in a new window] ,
Christine L. Snozek Open the ORCID record for Christine L. Snozek [Opens in a new window] ,
Ryan W. Stevens Open the ORCID record for Ryan W. Stevens [Opens in a new window]  and
Aditya Shah
Dan Ilges*
Affiliation:
Department of Pharmacy Services, Mayo Clinic Arizona, Phoenix, AZ, USA
Dylan Kosaski
Affiliation:
Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA
Maria Teresa Seville
Affiliation:
Division of Infectious Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
Alyssa K. McGary
Affiliation:
Division of Clinical Trials and Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA
John C. O’Horo
Affiliation:
Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
Christine L. Snozek
Affiliation:
Division of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
Ryan W. Stevens
Affiliation:
Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA
Aditya Shah
Affiliation:
Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
*
Corresponding author: Dan Ilges; Email: Ilges.daniel@mayo.edu
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Abstract

Objective:

To retrospectively observe procalcitonin (PCT) and antibiotic ordering practices in patients hospitalized with community-acquired pneumonia (CAP).

Design:

Retrospective, exact matched, multicenter cohort study from October 1, 2018 – March 31, 2023.

Setting:

All hospitals across the Mayo Clinic Enterprise.

Participants:

Adult patients with CAP, identified using pneumonia diagnosis codes and receipt of systemic antibiotics with an indication of “respiratory tract infection” within 48 hours of hospitalization.

Methods:

PCT testing within the first 7 days of hospitalization was compared to non-PCT care (nPCT). The primary outcomes were treatment duration, antibiotic days of therapy (DOT), and length of stay (LOS).

Results:

15364 patients met inclusion criteria. PCT testing occurred in 42.4% (6515/15364) of encounters, totaling 8214 PCT results. 12880 unique patient encounters were matched 1:1, 6440 in each group. Treatment duration was longer in the PCT group compared to the nPCT group (5.1 vs 4.6 days, respectively, P < 0.001). Patients in the PCT group also received more DOT (8.6 vs 7.6 DOT, P < 0.001) and had a longer LOS (6.8 vs 5.9 days, P < 0.001), respectively. There was no difference in 30-day all-cause mortality or C. difficile infection between groups. In a sensitivity analysis of nPCT patients compared to those with a peak value <0.25 ng/mL (i.e. normal result) there was no difference in treatment duration (4.6 days nPCT vs 4.7 days normal PCT, P = 0.104) or LOS (5.9 days nPCT vs 6.0 days normal PCT, P = 0.134).

Conclusion:

PCT testing in patients hospitalized with CAP was not associated with reduced antimicrobial utilization, LOS, or 30-day all-cause mortality.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 5 , May 2025 , pp. 519 - 525
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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