How Laboratory Leaders Are Leveraging PCT to Optimize Antibiotic Utilization

CLINICAL

Article highlights:

PCT testing is an effective way to avoid under- or over-utilization of antibiotics, reduce costs, and improve outcomes
PCT testing has helped health systems see impressive clinical and financial achievements
With PCT testing, health systems can help be a leader in antibiotic stewardship efforts

With the emergence of bacterial resistance to antibiotic agents, the healthcare and regulatory industries are making concerted strides to reduce unnecessary antibiotic use—including a mandate by the Joint Commission and proposed guidance from the Centers for Medicare and Medicaid Services. Without these efforts, as many as 71% of patients with acute respiratory-tract infections are prescribed antibiotics, despite that the majority of such infections have viral, rather than bacterial, causes. In the end, organizations are incurring unnecessary costs, increasing the risk of adverse events and harming public health in the long term.

As a result, health systems are looking for proven strategies to reduce their use of antibiotics—cutting the unnecessary costs of overuse—while improving outcomes for patients. Procalcitonin (PCT) testing has emerged as a strategy with not only a demonstrated clinical and health economic impact, but a proven track record in improving the financial health of organizations. Through the use of PCT testing, laboratory leaders have the opportunity to demonstrate the value of the lab with a win- win solution.

Advantages of PCT

The true value of PCT lies in the fact that it's both a highly sensitive and specific biomarker for bacterial infection for patients evaluated with sepsis and lower respiratory tract infections (LRTI), such as pneumonia, COPD, and bronchitis. As a result, PCT testing enables clinicians to closely track, over 24-hour intervals, both the approximate severity of a bacterial infection and the effectiveness of a treatment response. In other words, PCT testing helps clinicians to confidently administer optimal levels of antibiotics, while avoiding over or under utilization.

Meanwhile, because levels of PCT in the bloodstream become elevated solely in the presence of bacterial toxins and inflammation, PCT testing can help to effectively rule out viral or fungal causes of infection. Other indicators, such as lactate testing, c- reactive protein (CRP) testing, or blood culture testing have zero or limited efficacy in this area.

Finally, PCT is also an effective indicator for the severity of sepsis, as well as the efficacy of treatment. For example, the Procalcitonin Monitoring Sepsis (MOSES) study, performed by Thermo Fisher Scientific, found that the odds of patient of patient survival doubles if PCT levels are lowered by more than 80% within the first four days of treatment.

Demonstrated Real-World Effectiveness of PCT

While PCT testing is relatively new in the U.S., lab leaders are leveraging it to optimize antibiotic use and drive better clinical and financial outcomes.

In a ProHOSP trial, the BRAHMS PCT testing assay was able to assist clinical decision making to reduce antibiotic prescription rate and duration for patients with lower respiratory tract infections (LRTI), such as bronchitis, COPD, and pneumonia, without increasing the risk for serious adverse outcomes:

65% antibiotic reduction for bronchitis
50.4% antibiotic reduction for COPD
32.4% antibiotic reduction for community-acquired pneumonia

Five Rivers Medical Center, through PCT testing, was able to drive impressive clinical, financial, and antibacterial stewardship results:

47.1% reduction to antibacterial days of therapy
62% reduction in all hospital mortality
50% reduction to 30-day readmissions
50% reduction in adverse drug events

A comprehensive study analyzing over 619 patient encounters in the ICU found that PCT testing vs. non-PCT testing resulted in:

Lowered hospital costs by $2,759
Lowered ICU costs by $1,310
PCT-managed patients averaged 1.2 fewer days in the hospital and 0.7 fewer days of antibiotic exposure

Augmenting the Potential of PCT

Roche Diagnostics, with the Elecsys® BRAHMS PCT on the Roche automated platform, is offering further opportunity for laboratorians to reap the benefits of PCT testing. Already, Roche has partnered with institutions around the country to help realize their antibiotic stewardship goals.

For example, Washington Regional Medical Center switched to the Roche PCT platform in 2016 to capitalize on the labor-saving potential and cost-efficiencies of automation. Since the adoption of PCT, the organization has not only seen a decrease in sepsis mortality by 18%, but also projects cost savings from the program.

“In our institution, we have found that when we use PCT guidance for sepsis and antibiotic treatment decisions, we see that we're better stewards of antibiotics," said Washington Regional's Infectious Disease Specialist and Antibiotic Stewardship Director James Newton, M.D. “What's more, it's an affordable test. If I can get a patient out of the ICU a day or two earlier, I'm saving a significant amount of money."

Meanwhile, when PCT testing became available on the Roche platform, UC San Diego Health worked diligently to bring it to the health system. “The literature has shown the implications can be huge with regard to how long a patient stays in the hospital," said Dr. Sean-Xavier Neath, M.D., Ph.D, and professor of emergency medicine. “PCT provides a baseline of how sick a patient was when he or she came in, and from that, it can help inform treatment choices to ensure the best outcome." UC San Diego believes the Roche PCT system, which is still new to the hospital, will greatly inform treatment decisions and help to improve patient outcomes over time.

While PCT testing is still relatively new to U.S. markets, it's clear that PCT testing assays represent a significant opportunity for health organizations to minimize unnecessary costs, optimize antibiotic prescription and exposure, and drive better patient outcomes. With PCT, health systems can help become leaders in the effort to improve antibiotic stewardship, while taking steps to better public health over the long term.

Related resources

Procalcitonin for Antimicrobial Stewardship and the Management of Sepsis
by Nam K. Tran, PhD, MS, FACB, Director of Clinical Chemistry and POCT
Procalcitonin (PCT) is a peptide precursor to calcitonin that is associated with the inflammatory response to bacterial infection.
Multi-Center Clinical Study Confirms Decreased Levels of Procalcitonin as an Independent Predictor of Mortality in Patients with Severe Sepsis and Septic Shock
Thermo Fisher Scientific Inc. announces results from the multi-center Procalcitonin MOnitoring SEpsis (MOSES) Study have been published in the May 2017 print issue of Critical Care Medicine.
Procalcitonin-guided diagnosis and antibiotic stewardship revisited
Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy.