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Summarising the link between AMS and PCT

In this video, Dr Kordo Saeed discusses the impact PCT has on antimicrobial stewardship.
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Hello, everyone. I’m Dr. Kordo Saeed, and I would like to briefly talk about the impact of procalcitonin on antimicrobial stewardship in clinical practice. As we know, the emergence of multidrug-resistant organisms poses a major threat to global health. If you just take acute respiratory tract illnesses, there are numerous studies suggesting that patients are exposed to unnecessary antibiotics, even though a majority of these illnesses are viral in origin. The current COVID-19 pandemic showed this, too, as the majority of patients were given antibiotics during the hospital admissions. This was partly due to its novelty and partly due to lack of diagnostic markers in supporting the diagnosis of superadded bacterial infections.
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It means that most of these cases were given antibiotics just in case they have a secondary bacterial infection. Our real life experience is that by using procalcitonin to aid clinicians’ decision-making in the just-in-case antibiotic prescribing, we found that procalcitonin aided preventing 50% of these just-in-case antibiotics without negative impact on patients’ outcome. This was accounted for about 17% reduction in total antibiotic use in the acute medical admission unit and intensive care unit. It’s not only resulted in savings from antibiotic costs and hidden costs associated with antibiotic usage. But most importantly, patients were not exposed to just-in-case antibiotics. And undoubtedly, this would have impacted in reducing selection pressure on antibiotics.
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When we consider using procalcitonin as an anti-microbial stewardship tool, we should aim to have protocols for local use and guidance. This consensus paper which has been recently published by a group of international experts on procalcitonin use as a stewardship tool may be of help as they have proposed and provided various algorithms for various clinical settings.
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These are two of the algorithms the consensus paper provided and how procalcitonin can aid anti-microbial stewardship in the intensive care unit and outside intensive care units. Please note the different cutoff levels and the actions according to patients’ clinical presentation and where they are. It’s important to recognise the limitations of procalcitonin, which will be discussed throughout the course. This slide is just to highlight how we used the algorithms from the consensus paper for patients with COVID-19 during April to May 2020 at University Hospital Southampton NHS Foundation Trust. Patients with lower PCT cutoff levels were significantly less exposed to antibiotics, at least by two days without negative impact on the outcome or length of stay.
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I hope I have highlighted some uses of procalcitonin as part of an antimicrobial stewardship programme. As always, when trying to implement a new test, please assess local needs and requirements. Ideally, use the test as part of an algorithm or a local guideline to make sure the test itself is not getting misused. Thank you.

Dr Kordo Saeed discusses the impact of PCT on antimicrobial stewardship in clinical practice.

Multi-drug resistance organisms pose a major threat to global health and this can be linked to the misuse of antibiotics. Antibiotics are often used in “just in case” scenarios and the video covers how PCT can be used to reduce antibiotic use in these cases. Published work can help provide protocols that are required to guide the use of PCT.

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Procalcitonin: PCT as a Biomarker for Antimicrobial Stewardship

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