2239. Randomized Controlled Trial of a PROcalcitonin-Guided Antibiotic Treatment Algorithm Plus Antibiotic Stewardship the Pediatric Intensive Care Unit (ProPICU)

Abstract

BackgroundProcalcitonin (PCT) testing enables earlier antibiotic (abx) de-escalation in adult intensive care units (ICUs); similar data in children are lacking.MethodsSingle-center pragmatic randomized controlled trial of children admitted to the pediatric ICU and started on intravenous (IV) abx February 2018–April 2019 to evaluate whether a PCT-guided testing and treatment algorithm implemented through antibiotic stewardship (AS) audit and feedback promotes abx de-escalation in the pediatric ICU. Patients were randomized by month to either control or PCT arm. Exclusion criteria were receipt of IV abx within 7 days prior to enrollment, immune compromise, neonates < 34 weeks gestation, or receipt of abx for an infection requiring prolonged abx. All subjects had baseline AS review. Subjects in the PCT arm had PCT testing on days 0, 1, 2, and 4 and AS guidance. Some subjects in the control arm had baseline PCT testing that was not available to providers. Abx de-escalation = stopping or narrowing spectrum of abx; Abx escalation = broadening spectrum or starting an additional abx. The primary outcome was abx days of therapy (DOT) per patient in the first 14 days after enrollment. Kruskal–Wallis, Chi-square, and ANOVA tests were used.ResultsThe modified intention to treat analysis included 270 patients: 133 control and 137 PCT. Significantly more males and febrile patients were in the PCT-guided arm (Table 1). Overall, abx DOT did not differ between arms (Table 2). In 85 patients with pneumonia, median DOT per patient was shorter in the PCT than control arm (8.0 vs. 9.3 days, P = 0.04). Among patients in the PCT arm, those with initial PCT level > 0.5 mg/L (n = 93) (4.3 vs. 7.1 days, P = 0.006). More AS recommendations (recs) were made in the PCT arm (53 PCT vs. 35 control, P = 0.03). Compliance with AS recs was similar (70%) between arms.ConclusionIn the pediatric ICU, the use of a PCT testing and treatment algorithm with AS audit and feedback resulted in shorter abx DOT for patients with pneumonia and more AS recs compared with no PCT testing. PCT testing implemented with AS can reduce abx duration in select populations of critically ill children. DisclosuresRitu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.