Table 1.
Baseline Characteristics of Enrolled Patients
| Standard of Care (n = 131) | PCT Guidance (n = 125) | All Patients (N = 256) | |
|---|---|---|---|
| Age, mean (SD), yr | 78.0 (13.1) | 79.6 (9.8) | 78.6 (11.6) |
| Sex, M, n (%) | 62 (45.8) | 52 (40.8) | 114 (44.5) |
| Charlson’s comorbidity index, mean (SD) | 6.0 (2.4) | 5.6 (1.9) | 5.8 (2.2) |
| Septic shock, n (%) | 9 (6.9) | 9 (7.2) | 18 (7.0) |
| ΑPACHE II score, mean (SD) | 13.3 (4.7) | 13.0 (4.6) | 13.2 (4.7) |
| SOFA score, mean (SD) | 4.1 (2.2) | 4.1 (2.1) | 4.1 (2.2) |
| Procalcitonin, median (Q1–Q3), μg/L | 0.53 (0.15–5.03) | 0.86 (0.17–5.95) | 0.65 (0.17–5.77) |
| Meeting stopping rule on Day 5, n (%) | |||
| ≥80% decrease of initial serum PCT | 32 (24.4) | 35 (28.0) | 67 (26.2) |
| Serum PCT <0.5 μg/L | 74 (56.5) | 71 (56.8) | 145 (56.6) |
| Combined criteria | 92 (70.2) | 89 (71.2) | 181 (70.7) |
| Meeting stopping rule after Day 5*, n (%) | N/A | 20 (16.0) | N/A |
| Noncompliance with PCT stopping rule because of medical instability, n (%) | N/A | 13 (10.4) | N/A |
| Overall compliance with PCT stopping rule, n (%) | N/A | 96 (76.8) | N/A |
| Type of infection, n (%) | |||
| Community-acquired pneumonia | 57 (43.5) | 55 (44.0) | 112 (43.8) |
| Healthcare-associated pneumonia | 27 (20.6) | 16 (12.8) | 43 (16.8) |
| Acute pyelonephritis | 44 (33.6) | 51 (40.8) | 95 (37.1) |
| Primary bloodstream infection | 1 (0.8) | 2 (1.6) | 3 (1.2) |
| Hospital-acquired pneumonia | 2 (1.5) | 1 (0.8) | 3 (1.2) |
| Microbiological documentation, n (%) | |||
| E. coli | 22 (16.7) | 24 (19.2) | 46 (18.0) |
| K. pneumoniae | 7 (5.3) | 5 (4.0) | 12 (4.7) |
| P. aeruginosa | 2 (1.5) | 1 (0.8) | 3 (1.2) |
| S. pneumoniae | 8 (6.1) | 4 (3.2) | 12 (4.7) |
| H. influenzae | 8 (6.7) | 6 (5.0) | 14 (5.5) |
| S. aureus | 3 (2.3) | 3 (2.4) | 6 (2.3) |
| C. difficile | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Other | 6 (4.6) | 9 (7.2) | 15 (5.9) |
| Multidrug-resistant pathogen | 6 (4.6) | 4 (3.2) | 10 (3.9) |
| Extensively drug-resistant | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Pandrug-resistant | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Positive blood culture, n (%) | 23 (17.6) | 19 (15.2) | 42 (16.4) |
| Empiric treatment according to ESCMID guidelines, n (%)† | 112 (85.5) | 103 (82.4) | 215 (84.0) |
Definition of abbreviations: APACHE = Acute Physiology and Chronic Health Evaluation; C. difficile = Clostridioides difficile; E. coli = Escherichia coli; ESCMID = European Society of Clinical Microbiology and Infectious Diseases; H. influenzae = Haemophilus influenzae; K. pneumoniae = Klebsiella pneumoniae; N/A = not applicable; P. aeruginosa = Pseudomonas aeruginosa; PCT = procalcitonin; Q = quartile; S. aureus = Staphylococcus aureus; SOFA = Sequential Organ Failure Assessment; S. pneumoniae = Streptococcus pneumoniae.
Days 6 and 7.
Attending physicians and/or primary investigators were infectious diseases specialists, members of the ESCMID following the ESCMID guidelines for antimicrobial treatment. In addition, the Hellenic Society for Chemotherapy, incorporating European guidelines, has published in cooperation with the National Organization for Medicines an issues-tool, namely, “Guide of antimicrobial stewardship for the hospitalized patient and for primary care,” handed out in all Greek hospitals and also available online (17).