PROMOTING ANTIBIOTIC STEWARDSHIP IN PEDIATRICS USING A PROCALCITONIN ALGORITHM TO TREAT TRACHEITIS

Background: Antibiotic overuse is prominent in pediatrics and can lead to antimicrobial resistance, increased mortality rate, adverse events, drug toxicity, and clostridium difficile infections. Tracheitis is a common lower respiratory tract infection (LRTI) seen in the pediatric population, with majority of patients admitted to the intensive care unit (ICU). Prompt recognition and treatment of bacterial tracheitis are essential to preventing acute respiratory distress syndrome and sepsis. However, differentiating between a self-limiting respiratory tract infection or a more severe disease remains difficult. Clinicians typically err on the side of prescribing a longer course of antibiotics to avoid potentially life-threatening complications. Procalcitonin (PCT) has been shown to be a sensitive biomarker for bacterial infections. The level of PCT is directly proportional to the bacterial burden in the body, which gives PCT an advantage in antimicrobial stewardship. Literature demonstrates that PCT-guided care results in two to three-day reduction in total antibiotic days in LRTIs. Methodology: This was a single center QI project with retrospective data collection, guided by the Plan-Do-Study-Act framework. The setting was a 30-bed pediatric ICU at a children’s hospital in Southern California. The initial phase of the QI project included the development of a treatment algorithm based on serum PCT concentrations. The protocol was developed using data from peer-reviewed literature with the content validated by an expert panel. Sample included pediatric patients diagnosed with bacterial tracheitis between the ages of one month and 18 years. Measures included length of days on antibiotics, days in the ICU, total length of stay (LOS), and readmissions. Results: During the three-month pilot, 15 tracheitis patients met the inclusion criteria. Application of the PCT-guided protocol PROCalTM resulted in ten patients (67%) receiving five or fewer days of antibiotics compared to the usual seven-ten treatments. Application of PROCalTM successfully decreased LOS & ICU days in 47% of patients. This translates to an estimated direct cost savings of $36,400 per patient. Conclusion: PCT helps support clinician’s decision-making when discontinuing antibiotic therapy for tracheitis. The pilot demonstrated that implementing PROCalTM correctly helps decrease tracheitis treatment and subsequently ICU days. In the future PCT can also be used to guide decisions for initiation of antibiotic therapy for patients with tracheitis, as well as other clinical diagnoses