• Justin J Choi, Anna Cornelius-Schecter, Joshua A Hayden, Deanna Pereira Jannat-Khah, Alexander O'Connell, Amiran Baduashvili, Jennifer Lee, and Matthew W McCarthy.
• Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
• J Eval Clin Pract. 2020 Aug 1; 26 (4): 1220-1223.

ObjectivesThis study aims to better understand and describe antibiotic prescribing practices and adherence to a procalcitonin (PCT)-guided algorithm in patients undergoing serum PCT testing in adult hospitalized patients.MethodsWe performed an observational, retrospective study of 201 randomly selected patients who are aged ≥18 years, admitted to the general medicine floors or step-down unit between 1 January 2017 and 31 December 2017, and had serum PCT testing. Physician adherence to a PCT-guided algorithm was assessed through chart review.ResultsWe found an overall adherence of 64.7%. Adherence was highest for PCT values above 0.25 ng/mL (82.8% for 0.25-0.50 ng/mL and 83.6% for >0.50 ng/mL). Adherence was lower for PCT values less than 0.25 ng/mL (59% for <0.1 ng/mL and 38% for 0.1-0.24 ng/mL). Serial testing was performed in 10% of patients.ConclusionsHospital-based providers are more likely to overrule the algorithm and either initiate or continue antibiotics when guidelines encourage discontinuing antibiotics. These findings have important implications for antimicrobial stewardship and patient care and suggest that hospital-based providers may benefit from targeted didactics regarding the interpretation of the serum PCT assay.© 2019 John Wiley & Sons, Ltd.

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