Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis
Abstract Objective: It is unknown how providers are utilizing procalcitonin in the real world to make antibiotic prescribing decisions, and whether procalcitonin can limit harms related to antibiotic misuse. We examined how the probability of receiving antibiotics changed just below and above the...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2025-01-01
|
| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25000725/type/journal_article |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849719153502453760 |
|---|---|
| author | Leela Chockalingam Thomas Mee Tiffany Gardner Eric Grimm Amiran Baduashvili |
| author_facet | Leela Chockalingam Thomas Mee Tiffany Gardner Eric Grimm Amiran Baduashvili |
| author_sort | Leela Chockalingam |
| collection | DOAJ |
| description |
Abstract
Objective:
It is unknown how providers are utilizing procalcitonin in the real world to make antibiotic prescribing decisions, and whether procalcitonin can limit harms related to antibiotic misuse. We examined how the probability of receiving antibiotics changed just below and above the pre-specified procalcitonin cut-points. We sought to understand whether providers interpret procalcitonin as a dichotomous or continuous diagnostic test.
Design:
Retrospective cohort study.
Participants:
We included adult inpatients who had procalcitonin collected as part of routine care. Patients with procalcitonin collected more than 48 hours after the first antibiotic dose, those discharged from the emergency department, or those on an obstetrics service were excluded.
Methods:
We used administrative data from the Health Data Compass database (2018-2019) at the University of Colorado Hospital to examine the correlation of pre-specified procalcitonin cut-points (0.1, 0.25, and 0.5 ng/mL) with the antibiotic treatment decisions using a regression discontinuity analysis (RDA), stratified by level of care. We constructed receiver operating characteristic (ROC) curves depicting the relationship between procalcitonin level and antibiotic prescribing. We performed sensitivity analyses by varying bandwidth for RDA.
Results:
The study included 4383 patients. A total of 68.9% received a full antibiotic course. RDA did not demonstrate any discontinuity at the pre-specified cut-points. However, sensitivity analyses showed a potential discontinuity at the 0.25 ng/mL cut-point in the ICU subgroup. The ROC curves were consistent with the RDA findings.
Conclusions:
This study suggests that most clinicians in real-world settings interpret procalcitonin as a continuous diagnostic test when prescribing antibiotics.
|
| format | Article |
| id | doaj-art-77972281339e42bfbfda213bedbe3d82 |
| institution | DOAJ |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-77972281339e42bfbfda213bedbe3d822025-08-20T03:12:12ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.72Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysisLeela Chockalingam0https://orcid.org/0000-0003-1572-5138Thomas Mee1https://orcid.org/0000-0003-2517-1220Tiffany Gardner2https://orcid.org/0000-0003-0935-4342Eric Grimm3Amiran Baduashvili4https://orcid.org/0000-0001-8515-9835Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USAInternal Medicine Residency Program, University of Colorado School of Medicine, Aurora, CO, USAPulmonary & Critical Care Fellowship Program, Massachusetts General Hospital/Beth Israel Deaconess Medical Center, Boston, MA, USADivision of Hospital Medicine, University of Colorado - Anschutz Medical Campus, Aurora, CO, USADivision of Hospital Medicine, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA Abstract Objective: It is unknown how providers are utilizing procalcitonin in the real world to make antibiotic prescribing decisions, and whether procalcitonin can limit harms related to antibiotic misuse. We examined how the probability of receiving antibiotics changed just below and above the pre-specified procalcitonin cut-points. We sought to understand whether providers interpret procalcitonin as a dichotomous or continuous diagnostic test. Design: Retrospective cohort study. Participants: We included adult inpatients who had procalcitonin collected as part of routine care. Patients with procalcitonin collected more than 48 hours after the first antibiotic dose, those discharged from the emergency department, or those on an obstetrics service were excluded. Methods: We used administrative data from the Health Data Compass database (2018-2019) at the University of Colorado Hospital to examine the correlation of pre-specified procalcitonin cut-points (0.1, 0.25, and 0.5 ng/mL) with the antibiotic treatment decisions using a regression discontinuity analysis (RDA), stratified by level of care. We constructed receiver operating characteristic (ROC) curves depicting the relationship between procalcitonin level and antibiotic prescribing. We performed sensitivity analyses by varying bandwidth for RDA. Results: The study included 4383 patients. A total of 68.9% received a full antibiotic course. RDA did not demonstrate any discontinuity at the pre-specified cut-points. However, sensitivity analyses showed a potential discontinuity at the 0.25 ng/mL cut-point in the ICU subgroup. The ROC curves were consistent with the RDA findings. Conclusions: This study suggests that most clinicians in real-world settings interpret procalcitonin as a continuous diagnostic test when prescribing antibiotics. https://www.cambridge.org/core/product/identifier/S2732494X25000725/type/journal_article |
| spellingShingle | Leela Chockalingam Thomas Mee Tiffany Gardner Eric Grimm Amiran Baduashvili Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis |
| title_full | Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis |
| title_fullStr | Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis |
| title_full_unstemmed | Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis |
| title_short | Real-world interpretation of procalcitonin to guide antibiotic prescribing: a retrospective cohort study with regression discontinuity analysis |
| title_sort | real world interpretation of procalcitonin to guide antibiotic prescribing a retrospective cohort study with regression discontinuity analysis |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25000725/type/journal_article |
| work_keys_str_mv | AT leelachockalingam realworldinterpretationofprocalcitonintoguideantibioticprescribingaretrospectivecohortstudywithregressiondiscontinuityanalysis AT thomasmee realworldinterpretationofprocalcitonintoguideantibioticprescribingaretrospectivecohortstudywithregressiondiscontinuityanalysis AT tiffanygardner realworldinterpretationofprocalcitonintoguideantibioticprescribingaretrospectivecohortstudywithregressiondiscontinuityanalysis AT ericgrimm realworldinterpretationofprocalcitonintoguideantibioticprescribingaretrospectivecohortstudywithregressiondiscontinuityanalysis AT amiranbaduashvili realworldinterpretationofprocalcitonintoguideantibioticprescribingaretrospectivecohortstudywithregressiondiscontinuityanalysis |