Annals for Hospitalists Inpatient Notes - A Critical Look at Procalcitonin Testing in Pneumonia
Authors: Michael S. Pulia, Peter K. Lindenauer
Journal: Annals of Internal Medicine (2021)

Web ExclusivesJune 2021Annals for Hospitalists Inpatient Notes - A Critical Look at Procalcitonin Testing in PneumoniaMichael S. Pulia, MD, MS and Peter K. Lindenauer, MD, MScMichael S. Pulia, MD, MSUniversity of Wisconsin-Madison, Madison, Wisconsin (M.S.P.) and Peter K. Lindenauer, MD, MScInstitute for Healthcare Delivery and Population Science, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts (P.K.L.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-1913 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Antibiotic misuse for acute respiratory conditions is widespread, including in the acute care setting. Qualitative research suggests that much of this misuse can be attributed to diagnostic uncertainty (1). In the context of suspected pneumonia, uncertainty often stems from concerns about atypical presentations (for example, older adults), unreliable performance of chest radiographs, and the possibility of overlapping diagnoses. Uncertainty about the presence of a bacterial infection may influence providers to initiate empirical antibiotics "just in case" to avoid potential adverse outcomes related to delayed treatment. The importance of this problem is further underscored by the fact that viral infections are ...References1. Teixeira Rodrigues A, Roque F, Falcão A, et al. Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies. Int J Antimicrob Agents. 2013;41:203-12. [PMID: 23127482] doi:10.1016/j.ijantimicag.2012.09.003 CrossrefMedlineGoogle Scholar2. Self WH, Balk RA, Grijalva CG, et al. Procalcitonin as a marker of etiology in adults hospitalized with community-acquired pneumonia. Clin Infect Dis. 2017;65:183-190. [PMID: 28407054] doi:10.1093/cid/cix317 CrossrefMedlineGoogle Scholar3. Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017;10:CD007498. [PMID: 29025194] doi:10.1002/14651858.CD007498.pub3 CrossrefMedlineGoogle Scholar4. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200:e45-e67. [PMID: 31573350] doi:10.1164/rccm.201908-1581ST CrossrefMedlineGoogle Scholar5. Vaughn VM, Flanders SA, Snyder A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study. Ann Intern Med. 2019;171:153-163. [PMID: 31284301]. doi:10.7326/M18-3640 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Wisconsin-Madison, Madison, Wisconsin (M.S.P.)Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts (P.K.L.).Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health.Acknowledgment: The authors thank Valerie Vaughn, MD, MSc, for her feedback on an earlier draft of this manuscript.Grant Support: Dr. Pulia was supported by grant K08HS024342 from the Agency for Healthcare Research and Quality and grant 1UL1TR002373 from the Clinical and Translational Science Award program through the National Center for Advancing Translational Sciences of the National Institutes of Health. Dr. Lindenauer was supported by grant K24HL132008 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.Disclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-1913.Corresponding Author: Michael S. Pulia, MD, MS, University of Wisconsin-Madison, 800 University Bay Drive, Suite 310, Madison, WI 53562; e-mail, [email protected]wisc.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - June 2021 David H. Wesorick , Jawad Al-Khafaji , and Matthew Luzum Annals On Call - Procalcitonin in the Diagnosis of Bacterial Infection Robert M. Centor and David N. Gilbert Annals On Call - Procalcitonin Revisited Robert M. Centor and Joshua T. Stripling Metrics Cited byOptimizing antibiotic therapies to reduce the risk of bacterial resistance June 2021Volume 174, Issue 6Page: HO2-HO3 ePublished: 15 June 2021 Issue Published: June 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...