The null result for procalcitonin (PCT) on antibiotic utilization reported by Huang et al.1 is incongruent with our experience as an early emergency department (ED) adopter where rapid PCT has been ordered on over 4,000 patients since 2014. Procalcitonin’s ability to differentiate viral from bacterial infections is most impactful when diagnostic uncertainty exists vis-à-vis bronchitis versus pneumonia.2–4 As both conditions commonly have viral etiologies, PCT, if followed, has the potential to substantially reduce ED antibiotic prescribing.5 Unfortunately, these diagnoses comprised less than half of the trial subjects. For bronchitis, PCT guidance was adhered to in most cases yielding a 14.8% reduction in ED antibiotic prescribing.1 Conversely, in pneumonia cases, the PCT result was almost universally disregarded (77.7% of cases had negative PCT result yet 71.9% received antibiotics).1 Simply put, clinicians did not trust PCT even among a majority low risk cohort (60% PSI Class I and II) which attenuated the observed 4.4% reduction in ED antibiotic prescribing for pneumonia.1 Future work should focus on the utility of ED PCT when pneumonia is clinically suspected.
Acknowledgments
Grant: MP is a recipient of grant funding from the Agency for Healthcare Research and Quality (K08HS024342) that supported his effort on this correspondence.
Footnotes
Disclaimers: No potential conflict of interest relevant to this letter was reported.
Contributor Information
Michael S. Pulia, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Drive, Suite 310 – Room 346, Madison, WI 53705.
Lucas T. Schulz, Department of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, WI USA.
Barry C. Fox, Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI USA.
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