The overuse of antibiotics is a large problem in healthcare today, accelerating the
development of microbial resistance to antibiotics. Antibiotic stewardship campaigns
have been implemented to help clinicians curb their use. Procalcitonin is a serum peptide
and marker of inflammation secreted in response to microbial toxins. For this reason it is
more specific to bacterial infections than other markers of general inflammation , like Creactive
protein. The population of patients with sepsis in the Intensive Care Unit is one
in which extended durations of antibiotics are used. The FDA has approved use of
procalcitonin to guide de-escalation of antibiotic therapy in critically ill patients with
sepsis to avoid both antibiotic overuse and antibiotic related side effects. Review of
current literature shows that procalcitonin is efficacious in reducing duration of antibiotic
therapy in patients with sepsis in the ICU setting. This result, however, is not being
observed in clinical practice. This discrepancy is due to the inappropriate use of
procalcitonin that does not align with use outlined in randomized control trials. We
propose a study to determine how procalcitonin is being used in clinical practice in four
Boston area hospital Intensive Care Units. Through chart review, we will identify patients
in the Intensive Care Unit with sepsis from 2013-2018 recording patient demographic
information and patient characteristics. We will determine whether they had PCT
measured during their stay, and if they did, whether or not discontinuation of antibiotics
was in accordance with FDA’s proposed algorithm. We will aim to compare whether
discontinuing antibiotic therapy in accordance with the FDA’s procalcitonin deescalation
algorithm is associated with reduced duration of antibiotic therapy or incidence
of Clostridium Difficile infection. In conducting this study, we hope to identify patterns
of procalcitonin use in clinical practice and provide further evidence that using the
algorithm to guide therapy can serve as an effective tool in reducing exposure to
unnecessary antibiotics and the complications from their use.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/38647 |
| Date | 09 October 2019 |
| Creators | Danek, Kelly Jean |
| Contributors | Remick, Daniel, Weinstein, John R. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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