Hospital Procalcitonin Testing and Antibiotic Treatment of Patients Admitted for Chronic Obstructive Pulmonary Disease Exacerbation

Peter K Lindenauer, Meng-Shiou Shieh, Mihaela S Stefan, Kimberly A Fisher, Sarah D Haessler, Penelope S Pekow, Michael B Rothberg, Jerry A Krishnan, Allan J Walkey

Randomized trials suggest that assessment of serum procalcitonin (PCT) levels can be used to safely limit antibiotic use among patients hospitalized for exacerbations of COPD. To determine the impact of PCT testing on antibiotic treatment of patients hospitalized for exacerbations of COPD in routine practice. We conducted a series of cross-sectional and longitudinal multivariable analyses using data from 2009-2011 and 2013-2014 from a sample of 505 US hospitals Results: Of 203,177 patients hospitalized for COPD exacerbation in 2013-14, nearly 9 out of 10 were treated with antibiotics. Hospital PCT testing rates ranged from 0 to 83%. In cross-sectional analysis there was a weak negative association between the rate of PCT testing and risk-adjusted rates of antibiotic initiation (Spearman correlation -.12, p=.005); each 10 point increase in the percentage of patients undergoing PCT testing was associated with a 0.7% decline in risk-adjusted antibiotic use (p=.001). There was no association between hospital rates of PCT testing and duration of antibiotic treatment. In a longitudinal analysis, comparing treatment patterns in 2009-11 and 2013-14, we did not observe a significant difference in the change in antibiotic treatment rates or duration of therapy between hospitals that had adopted PCT testing compared to those that had not. As currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations. Implementation research is necessary in order to translate the promising outcomes from PCT testing observed in randomized trials into clinical practice.