Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations

Derek N. Bremmer, Briana E. DiSilvio, Crystal Hammer, Moeezullah Beg, Swati Vishwanathan, Daniel Speredelozzi, Matthew A. Moffa, Kurt Hu, Rasha Abdulmassih, Jina Makadia, Rikinder Sandhu, Mouhib Naddour, Noreen H. Chan-Tompkins, Tamara L. Trienski, Courtney Watson, Terrence J. Obringer, Jim Kuzyck, Thomas L. Walsh

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbations remain. Objective: To determine the impact of PCT guidance on antibiotic utilization for hospitalized adults with exacerbations of COPD. Design: A retrospective, pre-/post-intervention cohort study was conducted to compare the management of patients admitted with COPD exacerbations before and after implementation of PCT guidance. The pre-intervention period was March 1, 2014, through October 31, 2014, and the post-intervention period was March 1, 2015, through October 31, 2015. Participants: All patients with hospital admissions during the pre- and post-intervention period with COPD exacerbations were included. Patients with concomitant pneumonia were excluded. Intervention: Availability of PCT laboratory values in tandem with a PCT guidance algorithm and education. Main Measures: The primary outcome was duration of antibiotic therapy for COPD. Secondary objectives included duration of inpatient length of stay (LOS) and 30-day readmission rates. Key Results: There were a total of 166 and 139 patients in the pre- and post-intervention cohorts, respectively. There were no differences in mean age (66.2 vs. 65.9; P = 0.82) or use of home oxygenation (34% vs. 39%; P = 0.42) in the pre- and post-intervention groups, respectively. PCT guidance was associated with a reduced number of antibiotic days (5.3 vs. 3.0; p = 0.01) and inpatient LOS (4.1 days vs. 2.9 days; P = 0.01). Respiratory-related 30-day readmission rates were unaffected (10.8% vs. 9.4%; P = 0.25). Conclusions: Utilizing PCT guidance in the management of COPD exacerbations was associated with a decreased total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions.

Original languageEnglish (US)
Pages (from-to)692-697
Number of pages6
JournalJournal of general internal medicine
Volume33
Issue number5
DOIs
StatePublished - May 1 2018
Externally publishedYes

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Calcitonin
Chronic Obstructive Pulmonary Disease
Disease Progression
Anti-Bacterial Agents
Length of Stay
Inpatients
Pneumonia
Patient Readmission
Cohort Studies
Education
Therapeutics

Keywords

  • antibiotics
  • chronic obstructive pulmonary disease
  • procalcitonin

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations. / Bremmer, Derek N.; DiSilvio, Briana E.; Hammer, Crystal; Beg, Moeezullah; Vishwanathan, Swati; Speredelozzi, Daniel; Moffa, Matthew A.; Hu, Kurt; Abdulmassih, Rasha; Makadia, Jina; Sandhu, Rikinder; Naddour, Mouhib; Chan-Tompkins, Noreen H.; Trienski, Tamara L.; Watson, Courtney; Obringer, Terrence J.; Kuzyck, Jim; Walsh, Thomas L.

In: Journal of general internal medicine, Vol. 33, No. 5, 01.05.2018, p. 692-697.

Research output: Contribution to journalArticle

Bremmer, DN, DiSilvio, BE, Hammer, C, Beg, M, Vishwanathan, S, Speredelozzi, D, Moffa, MA, Hu, K, Abdulmassih, R, Makadia, J, Sandhu, R, Naddour, M, Chan-Tompkins, NH, Trienski, TL, Watson, C, Obringer, TJ, Kuzyck, J & Walsh, TL 2018, 'Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations', Journal of general internal medicine, vol. 33, no. 5, pp. 692-697. https://doi.org/10.1007/s11606-018-4312-2
Bremmer, Derek N. ; DiSilvio, Briana E. ; Hammer, Crystal ; Beg, Moeezullah ; Vishwanathan, Swati ; Speredelozzi, Daniel ; Moffa, Matthew A. ; Hu, Kurt ; Abdulmassih, Rasha ; Makadia, Jina ; Sandhu, Rikinder ; Naddour, Mouhib ; Chan-Tompkins, Noreen H. ; Trienski, Tamara L. ; Watson, Courtney ; Obringer, Terrence J. ; Kuzyck, Jim ; Walsh, Thomas L. / Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations. In: Journal of general internal medicine. 2018 ; Vol. 33, No. 5. pp. 692-697.
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abstract = "Background: Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbations remain. Objective: To determine the impact of PCT guidance on antibiotic utilization for hospitalized adults with exacerbations of COPD. Design: A retrospective, pre-/post-intervention cohort study was conducted to compare the management of patients admitted with COPD exacerbations before and after implementation of PCT guidance. The pre-intervention period was March 1, 2014, through October 31, 2014, and the post-intervention period was March 1, 2015, through October 31, 2015. Participants: All patients with hospital admissions during the pre- and post-intervention period with COPD exacerbations were included. Patients with concomitant pneumonia were excluded. Intervention: Availability of PCT laboratory values in tandem with a PCT guidance algorithm and education. Main Measures: The primary outcome was duration of antibiotic therapy for COPD. Secondary objectives included duration of inpatient length of stay (LOS) and 30-day readmission rates. Key Results: There were a total of 166 and 139 patients in the pre- and post-intervention cohorts, respectively. There were no differences in mean age (66.2 vs. 65.9; P = 0.82) or use of home oxygenation (34{\%} vs. 39{\%}; P = 0.42) in the pre- and post-intervention groups, respectively. PCT guidance was associated with a reduced number of antibiotic days (5.3 vs. 3.0; p = 0.01) and inpatient LOS (4.1 days vs. 2.9 days; P = 0.01). Respiratory-related 30-day readmission rates were unaffected (10.8{\%} vs. 9.4{\%}; P = 0.25). Conclusions: Utilizing PCT guidance in the management of COPD exacerbations was associated with a decreased total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions.",
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T1 - Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations

AU - Bremmer, Derek N.

AU - DiSilvio, Briana E.

AU - Hammer, Crystal

AU - Beg, Moeezullah

AU - Vishwanathan, Swati

AU - Speredelozzi, Daniel

AU - Moffa, Matthew A.

AU - Hu, Kurt

AU - Abdulmassih, Rasha

AU - Makadia, Jina

AU - Sandhu, Rikinder

AU - Naddour, Mouhib

AU - Chan-Tompkins, Noreen H.

AU - Trienski, Tamara L.

AU - Watson, Courtney

AU - Obringer, Terrence J.

AU - Kuzyck, Jim

AU - Walsh, Thomas L.

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N2 - Background: Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbations remain. Objective: To determine the impact of PCT guidance on antibiotic utilization for hospitalized adults with exacerbations of COPD. Design: A retrospective, pre-/post-intervention cohort study was conducted to compare the management of patients admitted with COPD exacerbations before and after implementation of PCT guidance. The pre-intervention period was March 1, 2014, through October 31, 2014, and the post-intervention period was March 1, 2015, through October 31, 2015. Participants: All patients with hospital admissions during the pre- and post-intervention period with COPD exacerbations were included. Patients with concomitant pneumonia were excluded. Intervention: Availability of PCT laboratory values in tandem with a PCT guidance algorithm and education. Main Measures: The primary outcome was duration of antibiotic therapy for COPD. Secondary objectives included duration of inpatient length of stay (LOS) and 30-day readmission rates. Key Results: There were a total of 166 and 139 patients in the pre- and post-intervention cohorts, respectively. There were no differences in mean age (66.2 vs. 65.9; P = 0.82) or use of home oxygenation (34% vs. 39%; P = 0.42) in the pre- and post-intervention groups, respectively. PCT guidance was associated with a reduced number of antibiotic days (5.3 vs. 3.0; p = 0.01) and inpatient LOS (4.1 days vs. 2.9 days; P = 0.01). Respiratory-related 30-day readmission rates were unaffected (10.8% vs. 9.4%; P = 0.25). Conclusions: Utilizing PCT guidance in the management of COPD exacerbations was associated with a decreased total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions.

AB - Background: Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbations remain. Objective: To determine the impact of PCT guidance on antibiotic utilization for hospitalized adults with exacerbations of COPD. Design: A retrospective, pre-/post-intervention cohort study was conducted to compare the management of patients admitted with COPD exacerbations before and after implementation of PCT guidance. The pre-intervention period was March 1, 2014, through October 31, 2014, and the post-intervention period was March 1, 2015, through October 31, 2015. Participants: All patients with hospital admissions during the pre- and post-intervention period with COPD exacerbations were included. Patients with concomitant pneumonia were excluded. Intervention: Availability of PCT laboratory values in tandem with a PCT guidance algorithm and education. Main Measures: The primary outcome was duration of antibiotic therapy for COPD. Secondary objectives included duration of inpatient length of stay (LOS) and 30-day readmission rates. Key Results: There were a total of 166 and 139 patients in the pre- and post-intervention cohorts, respectively. There were no differences in mean age (66.2 vs. 65.9; P = 0.82) or use of home oxygenation (34% vs. 39%; P = 0.42) in the pre- and post-intervention groups, respectively. PCT guidance was associated with a reduced number of antibiotic days (5.3 vs. 3.0; p = 0.01) and inpatient LOS (4.1 days vs. 2.9 days; P = 0.01). Respiratory-related 30-day readmission rates were unaffected (10.8% vs. 9.4%; P = 0.25). Conclusions: Utilizing PCT guidance in the management of COPD exacerbations was associated with a decreased total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions.

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