Procalcitonin testing may reduce antibiotic use in acute pancreatitis

Siriwardena is employed by the Manchester University NHS Foundation Trust. Please see the study for all other authors relevant financial disclosures.

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Procalcitonin-guided care reduced antibiotic use without increasing the risk for infection among patients with acute pancreatitis compared with standard care, according to research published in The Lancet Gastroenterology and Hepatology.

“None of these features [of acute pancreatitis] discriminate between inflammation and infection, resulting globally in overuse of antibiotics across the spectrum of disease severity, with up to two-thirds of patients with acute pancreatitis receiving at least one course of antibiotics during their admission. One method of distinguishing infection from inflammation is by measurement of serum procalcitonin,” Ajith K. Siriwardena, MD, professor of biology, health and life sciences at the University of Manchester and consultant at the Manchester Royal Infirmary in the United Kingdom, and colleagues wrote. “Algorithms based on measurement of procalcitonin have been developed as a means of differentiating bacterial sepsis from a systemic inflammatory response in a range of settings.”

study data

In a patient-blinded, randomized controlled trial, Siriwardena and colleagues sought to determine whether a procalcitonin measurement algorithm could reduce antibiotic use in adults with acute pancreatitis, compared with usual care.

Among 260 participants (mean age, 50.9 years; 51% men), 132 patients received procalcitonin-guided care and were tested for procalcitonin on days 0, 4, 7 and weekly thereafter. Following a test value of less than 1 ng/mL patients either stopped or did not start an antibiotic regimen; test values of 1 ng/mL or higher prompted continuation of antibiotics. The remaining patients (n = 128) received usual care. The primary studied outcome was the use of antibiotics during hospital admission.

According to study results, clinicians prescribed antibiotics to 45% of patients in the study arm compared with 63% of patients in the control arm (adjusted risk difference: –15.6%; 95% CI, –27 to –4.2). The odds ratio for the treatment effect was 0.49 (95% CI, 0.29-0.83). Compared with the control arm, patients in the study arm had fewer days of antibiotic use (5.8 vs. 4.5), although the likelihood of hospital readmission for acute pancreatitis was slightly higher among patients in the study arm (11% vs. 6%).

“The results show that use of the procalcitonin algorithm significantly decreased the probability of being prescribed an antibiotic. Sensitivity analyses of the primary outcome supported the validity of this finding,” Siriwardena and colleagues wrote. “When antibiotic use was adjusted to exclude mandated antibiotic prophylaxis for cholecystectomy or other interventional procedures, procalcitonin-guided care still significantly decreased the probability of being prescribed an antibiotic.”

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