Procalcitonin Reduces Overuse of Antibiotics in Nursing Facility Residents: A Quality Improvement Initiative

Procalcitonin (PCT), a biomarker for bacterial infections, has been studied in different clinical settings, including primary care, emergency departments, and intensive care units. Much less in nursing facilities (NFs), where antibiotic use is usually excessive. The aim of this quality assurance performance improvement initiative was to determine the effectiveness and sustainability of PCT in reducing unnecessary antibiotics in a 304-bed skilled NF. The initiative consisted of: (1) a 9-month baseline as a reference point; (2) a 9-month intervention where eligible residents were tested for PCT to help guide and monitor their antibiotic treatments. During the intervention, the plan-do-study-act cycle was applied to gauge the initiative, and control charts were used to determine the intervention success; and (3) a 9-month follow-up to validate the PCT effectiveness. The control chart rule of ≥8 consecutive months below the chart centerline indicated that the PCT intervention was successful. Monthly number of residents on antibiotics decreased from 34 at baseline down to 24 at follow-up, an overall 29% reduction. Days of therapy and antibiotic starts decreased from 33.0 and 5.4 at baseline down to 21.6 and 4.2 at follow-up, an overall reduction of 35% and 22%, respectively. Thus, utilization of PCT as a tool of antibiotic stewardship was associated with a reduction in antibiotic overuse among residents in this skilled NF.