Médecine pulmonaire et respiratoire

Clinical Utility of Procalcitonin-Guided Antibiotic Discontinuation in Hospitalized Pneumonia Patients in Daily Clinical Practice

Abstract

Satoshi Takeda*, Nobuhiko Nagata,Takanori Akagi, Taishi Harada, Hiroyuki Miyazaki, Shinichiro Ushijima, Takashi Aoyama, Yuji Yoshida, Hiroshi Yatsugi, Kenji Wada, Nobumitsu Ikeuchi, Yusuke Ueda, Hiroshi Ishii, Masaki Fujita and Kentaro Watanabe

Background: The optimal duration of antibiotic treatment has not been established for pneumonia patients.
Methods: We retrospectively enrolled hospitalized community-acquired or healthcare-associated pneumonia
patients in whom antibiotics were discontinued on the day or next day of procalcitonin (PCT) measurement between
2014 and 2017 (PCT-guided group, n=272). During the period, PCT was measured serially, and physicians were
encouraged to discontinue antibiotics according to the predefined PCT levels. The remaining patients admitted
during the same period were included as control 1 (n=133). Those admitted between 2010 and 2014, during which
period PCT was not measured serially, were also included in the study as control 2 (n=287). Primary endpoints were
duration of antibiotic treatment and recurrence of pneumonia within 30 days after antibiotic discontinuation.
Results: Though PCT-guided group included significantly more severe pneumonia patients than control 1 group
(p<0.001), duration of antibiotic treatment of the former (median 8.0 days) was not significantly different from the
latter (median 9.0 days, p=0.9043). While pneumonia severity was not different between the PCT-guided and control
2 groups, duration of antibiotic treatment of the former was significantly shorter than that of the latter (median
10.0 days, p<0.001). Multivariable regression analysis revealed that PCT-guided antibiotic discontinuation was
significantly related to duration of antibiotic treatment in both of PCT-guided and control 1 groups (p=0.0131), and
PCT-guided and control 2 groups (p<0.001). Pneumonia recurrence within 30 days after antibiotic discontinuation
of PCT-guided group (6.6%) was not statistically different from control 1 (3.0%) and 2 (5.9%) groups, respectively.
Analysis regarding pneumonia patients with low PCT levels on admission revealed similar results.
Conclusion: PCT-guided antibiotic discontinuation might be useful for shortening the duration of antibiotic
treatment without increasing pneumonia recurrence in daily clinical practice irrespective of PCT levels on admission