A real-world assessment of procalcitonin combined with antimicrobial stewardship in a community ICU.

PURPOSE: We evaluated the feasibility and impact of PCT-guided antibiotic duration combined with an established antibiotic stewardship program (ASP) in a community hospital intensive care unit (ICU). METHODS: We implemented daily PCT levels for ICU patients receiving antibiotics. Our protocol recommended stopping antibiotic therapy if PCT met an absolute or relative stopping threshold. We evaluated the adherence to stopping criteria within 48 h, antibiotic use [days of therapy (DOT) per 1000 patient-days (PD)], length of stay and ICU-mortality. We performed interrupted time series analysis to compare 24 months before and 12 months after implementation. RESULTS: A total of 297 antibiotic courses were monitored with PCT in 217 patients. Protocol adherence was 34% (absolute threshold: 39%, relative threshold: 12%). Antibiotic use pre-PCT was 935 DOTs/1000 PDs and post-PCT was 817 DOTs/1000 PDs (RRadj 0.73, 95% CI: 0.62 to 0.86). No statistically significant changes in clinical outcomes were noted. CONCLUSION: In the context of an established ASP in a community hospital ICU, PCT monitoring was feasible and associated with an adjusted overall decrease of 27% in antibiotic use with no adverse impact on clinical outcomes. Incorporating PCT testing to guide antibiotic duration can be successful if integrated into workflow and paired with ASP guidance.

Point of care ultrasound for basic haemodynamic assessment: novice compared with an expert operator.

Miniaturization of ultrasound equipment has led to the development of hand-held echocardiography devices suitable for bedside evaluation of cardiac function. Basic assessment of the haemodynamic state can be performed using a limited transthoracic echocardiography examination. This study evaluated a third generation device (SonoSite Titan) used by novice and expert operators. Limited transthoracic examination was performed on 30 healthy volunteers by an expert and a novice operator. The novice had performed 10 studies prior to data accrual. Agreement analysis was performed using weighted least products regression and Bland-Altman analysis. Acceptable results for the novice were achieved following 20 studies (including practice sessions) for basic haemodynamic assessment and following 40 studies for all measured parameters. The SonoSite Titan is acceptable for basic transthoracic measurements to determine the basic haemodynamic state and cardiac output measurements. We recommend a minimum of 20 training studies for novice operators prior to clinical use.