Association Between Procalcitonin and Antibiotics in Children With Community-Acquired Pneumonia.

TitleAssociation Between Procalcitonin and Antibiotics in Children With Community-Acquired Pneumonia.
Publication TypeJournal Article
Year of Publication2022
AuthorsSekmen M, Johnson J, Zhu Y, Sartori LF, Grijalva CG, Stassun J, Arnold DH, Ampofo K, Robison J, Gesteland PH, Pavia AT, Williams DJ
JournalHosp Pediatr
Volume12
Issue4
Pagination384-391
Date Published2022 Apr 01
ISSN2154-1671
KeywordsAnti-Bacterial Agents, Calcitonin, Child, Community-Acquired Infections, Humans, Pneumonia, Procalcitonin
Abstract

OBJECTIVE: To determine whether empirical antibiotic initiation and selection for children with pneumonia was associated with procalcitonin (PCT) levels when results were blinded to clinicians.

METHODS: We enrolled children <18 years with radiographically confirmed pneumonia at 2 children's hospitals from 2014 to 2019. Blood for PCT was collected at enrollment (blinded to clinicians). We modeled associations between PCT and (1) antibiotic initiation and (2) antibiotic selection (narrow versus broad-spectrum) using multivariable logistic regression models. To quantify potential stewardship opportunities, we calculated proportions of noncritically ill children receiving antibiotics who also had a low likelihood of bacterial etiology (PCT <0.25 ng/mL) and those receiving broad-spectrum therapy, regardless of PCT level.

RESULTS: We enrolled 488 children (median PCT, 0.37 ng/mL; interquartile range [IQR], 0.11-2.38); 85 (17%) received no antibiotics (median PCT, 0.32; IQR, 0.09-1.33). Among the 403 children receiving antibiotics, 95 (24%) received narrow-spectrum therapy (median PCT, 0.24; IQR, 0.08-2.52) and 308 (76%) received broad-spectrum (median PCT, 0.46; IQR, 0.12-2.83). In adjusted analyses, PCT values were not associated with antibiotic initiation (odds ratio [OR], 1.02, 95% confidence interval [CI], 0.97%-1.06%) or empirical antibiotic selection (OR 1.07; 95% CI, 0.97%-1.17%). Of those with noncritical illness, 246 (69%) were identified as potential targets for antibiotic stewardship interventions.

CONCLUSION: Neither antibiotic initiation nor empirical antibiotic selection were associated with PCT values. Whereas other factors may inform antibiotic treatment decisions, the observed discordance between objective likelihood of bacterial etiology and antibiotic use suggests important opportunities for stewardship.

DOI10.1542/hpeds.2021-006510
Alternate JournalHosp Pediatr
PubMed ID35362055