Procalcitonin Guided Antibiotic Stewardship in Pediatric Sepsis and Lower Respiratory Tract Infections.

ABSTRACT

OBJECTIVES: To determine the impact of procalcitonin-guided antibiotic stewardship protocol (PCT-ASP) in children admitted with sepsis and lower respiratory tract infection on the duration of antibiotic therapy and clinical outcome. METHODS: This was a single-center study involving children with infections treated with antibiotic therapy according to the PCT-ASP as the study group. The control group consisted of children with same age and diagnosis who were treated with antibiotics according to individual unit protocol before the implementation of PCT-ASP. The primary outcome was median duration of antibiotic therapy and hospital stay. RESULTS: Among 127 patients, 66 were enrolled in the study and 61 in the control group respectively. The median (IQR) PCT values at admission, day 4 and day 6 of antibiotic therapy were 5.59 (61.3), 2.57 (47.35), and 0.35 (0.47) ng/ml respectively, and showed a decreasing trend. All the children in the control group received antibiotics at admission while 12% of children in the study group were not initiated on antibiotics. In the study group, 53% of the children received antibiotics only for three days in the absence of treatment failure. The duration of antibiotics (p = 0.001) and hospital stay (p = 0.03) were less in the study group when compared to the control group. CONCLUSIONS: PCT-ASP reduces the duration of antibiotics and duration of hospital stay without increasing morbidity and mortality.