In this episode I’ll:
1. Discuss an article about procalcitonin effects on patient outcomes.
2. Answer the drug information question “Is cefepime 1g q6h just as good as 2g q8h for patients receiving continuous renal replacement therapy?”
3. Share a resource for aggregating journal articles.
Article
Lead author: Robert A. Balk
Published in the journal CHEST January 2017.
Background
There is tremendous interest in being able to diagnose sepsis with an objective, readily available test such as procalcitonin. The hope is that an objective test would allow for faster identification of sepsis and more rapid discontinuation of unnecessary antibiotics. These surrogate outcomes in turn should lead to improved hard outcomes such as reduced mortality.
Methods
The authors of this trial conducted a retrospective analysis of the Premier Healthcare Database for patients admitted to the ICU with one to two procalcitonin evaluations on day 1 of ICU admission vs patients who did not have procalcitonin testing. Funding for the study was provided by a company that sells procalcitonin tests.
Results
Over 33,000 procalcitonin managed patients were matched with over 98,000 non-procalcitonin matched patients. Patients who had procalcitonin levels tested on ICU admission had significantly decreased length of stay (both hospital and ICU), lower hospital costs, less antibiotic exposure, and a better chance of being discharged home. Mortality was no different between groups.
Conclusion
The authors concluded:
Use of PCT testing on the first day of ICU admission was associated with significantly lower hospital and ICU lengths of stay, as well as decreased total, ICU, and pharmacy cost of care. Further elucidation of clinical outcomes requires additional data.
Discussion
The results of this retrospective study do suggest that procalcitonin testing on ICU admission is associated with better patient outcomes. What is not clear is: How exactly should a clinician interpret procalcitonin results in a given patient to achieve better patient outcomes? The study took retrospective data from a wide variety of hospitals which presumably all have different interpretation guidelines for a given procalcitonin result. Procalcitonin is not a lab test routinely ordered at my institution, and I don’t see the results of this study changing that.
My unscientific twitter poll showed that nearly three-quarters of respondents do not routinely check procalcitonin levels on ICU admission:
Do you routinely check procalcitonin on ICU admission?
— Pharmacy Joe ?? (@PharmacyJoe) January 9, 2017
Drug information question
Q: Is cefepime 1g q6h just as good as 2g q8h for patients receiving continuous renal replacement therapy?
A: Yes
A study published in the International Journal of Antimicrobial Agents used pharmacokinetic modeling to describe the population pharmacokinetics of cefepime in patients undergoing continuous renal replacement therapy. The authors examined multiple dosing schedules for cefepime and multiple ultrafiltration flow rates against a theoretical MIC of 8 mg/L. The authors concluded:
Dosing simulations show that a dose of 2g q8h or 1g q6h is needed to ensure rapid achievement of adequate levels if the UFR is ≥1500 mL/h and 1g q8h for low UFR (≤1000 mL/h).
Resource
The resource for this episode was submitted by Z Hodges in the free Pharmacy Nation Slack Group. Read by QxMD helps you keep up-to-date with groundbreaking research in your area of practice. You can use your existing university affiliation and subscription to get PDF articles from medical journals on your iPad, iPhone, Android and web-enabled desktop.
I was able to install this app on my android phone, but I had to use the desktop version to add keywords to follow. This app seems like a much more convenient version of saved searches in Pubmed, which I discussed in episode 7. As with any journal aggregator service, be very judicious about how many journals or keywords you follow. It is very easy to follow too many journals and keywords and become overwhelmed.
Every week in the Critical Care Pharmacy Academy, I keep pharmacists up to date on the latest critical care literature. I summarize the most important articles that are relevant to critical care pharmacy, and give my opinion of how they can be applied to practice. You can find out more by going to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Correct! It is very easy to get overwhelmed with too many resources.