Procalcitonin: Lessons Learned and Ideas for the Future

Contributing Lab Leader: Michael Broyles, BSPharm, RPh, PharmD

Clinical

Article highlights:

The benefits of procalcitonin (PCT) are well established, especially when it comes to fighting sepsis.
PCT implementation is either lacking altogether or insufficient in many hospitals.
Laboratory leaders can boost PCT use by educating physicians about its clinical applications.

When it comes to fighting sepsis, the benefits of procalcitonin (PCT) have been well known for years. The problem: Too few physicians order the biomarker when it's warranted—and many of those who do end up ignoring the results.

Here, one early adopter of procalcitonin—Michael Broyles, BSPharm, RPh, PharmD, director of pharmacy and laboratory services at Five Rivers Medical Center in Pocahontas, Arkansas—shares what he's learned about the barriers to PCT implementation and the things that laboratories can do moving forward to avoid similar setbacks in the future.

Misunderstandings—and Missing Technology

“PCT adoption," Dr. Broyles says, “has always been an issue to me." In the past, he notes, many physicians thought they knew more than they really did about the pathophysiology of conditions like sepsis, which meant the benefits of PCT were often lost on them. “They didn't understand, they didn't work through cases, and so because they read an abstract in a journal that maybe wasn't very well done, they came to a consensus—on their own—that this test was another white count, another CRP [C- reactive protein] with all of its failings and shortcomings."

Other reasons for the general lag in PCT acceptance included a lack of relevant literature based on U.S. studies, and inadequate technologies for using it in practice. “For a long time we simply just had only a few instruments that PCT was available on," Dr. Broyles notes. “So there was just a cascade of events that made the adoption of PCT very slow."

On Providing the Information

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Michael Broyles, BSPharm, RPh, PharmD

Director of Pharmacy and Laboratory Services

Five Rivers Medical Center, Pocahontas, Arkansas

A Need for More Education

Today, Dr. Broyles estimates, around six in 10 hospitals in the United States have PCT, “but probably 99 percent don't use it to its full capacity" because most physicians don't understand its potential applications. He recently published a study showing how in his own organization they used PCT to help reduce antibiotic use by 47 percent. “We reduced 30-day readmissions by half, we reduced mortality by half, and we reduced Clostridium difficile infections by 64 percent." One clinician at the hospital who saw the results couldn't believe they were true, Dr. Broyles recalls. “It was, 'Wait a minute, this doesn't make sense. Half as many antibiotics and yet our outcomes are almost twice as good? How can that be?'"

His answer, Dr. Broyles says, was the same one he gives any clinician who thinks antibiotics are usually the best choice. “The key is providing the information—the education." His recommendation to others who are struggling to convince their own clinical teams to embrace PCT? Point them to the current literature, which now includes numerous studies on procalcitonin and antibiotics, and persuade them to join your antibiotic stewardship (ABS) committee and get to know the people working in the laboratory. Demonstrate to those clinicians how PCT works, Dr. Broyles says, and show them how it can help your organization achieve better outcomes, and it won't take long to convince them to change.

Contributing Lab Leaders