Impact of a Pharmacist-Managed Procalcitonin Program on COVID-19 Respiratory Tract Infection Outcomes and Health Care Resource Utilization.

Abstract

BackgroundPatients hospitalized with COVID-19 often receive empiric antibiotic coverage. Procalcitonin (PCT) is a biomarker with FDA approved guidance cutoffs for antibiotic use in lower respiratory tract infections. Herein we describe the implementation and impact of a pharmacist managed PCT monitoring program in hospitalized patients with COVID-19.MethodsIn this quasi-experimental, single-center, retrospective study of a prospective antimicrobial stewardship pharmacist managed program, inpatients who were SARS-CoV-2 PCR positive were reviewed during weekday, working hours and evaluated for appropriateness of antibiotic treatment by utilizing the PCT biomarker. As needed, the ID pharmacist offered feedback around antibiotic discontinuation in patients with PCT values ≤0.25 ng/mL. Adherence to PCT cutoffs, clinical outcomes, and utilization of healthcare resources were quantified and compared to a time-frame immediately preceding the program’s implementation.ResultsA total of 772 patients hospitalized with COVID-19 were analyzed. The pre-intervention cohort was comprised of 519 patients, and 253 patients were included after program implementation. Antibiotics were prescribed within 72 hours of admission to 232 (44.7%) and 108 (42.7%) patients during the control and intervention phases, respectively. There was no difference in the primary outcome of percentage of patients who received >1 day of antibiotic therapy (23.5% vs 21.7%, p = 0.849), or in any secondary outcome including hospital length of stay, 30 day readmission rates, or discharge disposition.ConclusionsIn a hospital where the majority of COVID-19 patients did not receive empiric antibiotics, the implementation of a pharmacist managed PCT monitoring program did not significantly decrease antibiotic use or healthcare resource utilization.