Reduction in the use of unnecessary antibiotics and the procalcitonin measurement tool (PCT)

Dr Kordo Saeed, Consultant Microbiologist with the Winchester and Eastleigh NHS Trust, talks about a six-month trial evaluating the serum procalcitonin concentration (PCT) measurement, as a diagnostic tool to support clinical decision making to either administer or withhold antibiotics in situations where there is a suspicion of bacterial infection, but the diagnosis is uncertain.

During the six-month trial, 99 patients on a medical admission unit (MAU) with suspected infection, and 42 patients on an intensive care unit (ICU) with clinical signs or physiological parameters suggesting possible new infection, had serum PCT concentration measured, with the results available within 90 minutes of the request. The test was initiated by the microbiology/infection team during clinical consultations to support the antibiotic decision. On the basis of low PCT values, antibiotics were withheld, in MAU on 52 occasions and in ICU on 42 occasions.

Patients were monitored over a week. There was neither progression of bacterial infection requiring antibiotics, or complications, or infection-related mortality in any patients who were denied antibiotics. Without the PCT value it is likely that all of these patients would have received empirical antibiotics.