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COPD: sputum and exacerbations
P113 Procalcitonin (PCT) is a safe and reliable biomarker of bacterial infection in exacerbations of COPD—so why is it so challenging to introduce it into a large UK hospital?
  1. L Burke,
  2. M Alhajji,
  3. N Todd,
  4. J S White
  1. York Hospitals, York, UK

Abstract

Background Antibiotics have only marginal efficacy in treating acute exacerbations of COPD (AECOPD). There is a large body of evidence that supports the use of PCT as a marker of bacterial infection. In York hospital patients with AECOPD account for a significant proportion of acute admissions and many are treated with antibiotics without strong evidence of a bacterial cause.

Objective To conduct a service evaluation of antibiotic prescribing following the introduction of PCT in patients with AECOPD. To observe attitudes towards and uptake of the test, and identify barriers to implementation.

Methods The evaluation ran from November 2009 to June 2010. Information on PCT was introduced to all physicians, and an algorithm for use was provided. Medical notes were reviewed from patients where PCT was requested. Evidence of documentation of PCT and whether it had been acted upon were recorded along with antibiotic use, length of stay and readmission within 1 month of discharge.

Results 54 PCT tests were performed and 49 were included in the final analysis. 32 (65%) of samples were below the cut-off for antibiotics, but were still prescribed in 11 cases. Of those above the threshold for treatment three did not receive antibiotics. PCT was documented and acted upon in only 12 (24%) patients. Overall, antibiotics were used in 25 (51%) patients. Two patients were readmitted with AECOPD within 1 month of discharge having been managed according to PCT results, with one receiving antibiotics. 24 (49%) samples were not reported on the day they were taken.

Conclusion 11 RCTs from different countries enrolling over 3500 patients have demonstrated the feasibility and safety of PCT in guiding antibiotic prescribing. Our service evaluation showed that despite this, introducing it into a hospital setting is challenging. If the algorithm had been followed correctly 65% of patients would not have received antibiotics. Physicians often rely on clinical judgement and well-known markers of infections such as CRP and WCC. Education of physicians along with timely availability of the test play significant roles. We intend to persevere and report our results aiming to improve the use of PCT within our hospital.

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