Written by Kimi Dunbar
Spoon Feed
Procalcitonin testing for patients with bronchiolitis has increased fourteen-fold from 2016-2022 without any change in antibiotic prescribing.
Synopsis
This multicenter, retrospective cross-sectional study analyzed procalcitonin (PCT) testing trends for bronchiolitis in infants aged 2–23 months from 2016 to 2022 across 38 hospitals. Using the Pediatric Health Information Systems (PHIS) database, 366,643 bronchiolitis encounters were examined, revealing a 14-fold increase in PCT testing (0.2% in 2016 to 2.8% in 2022, p<0.001). However, PCT usage varied widely (0.01%–8.29%) and was not associated with decreased antibiotic use (r=0.31, p=0.06) or admissions. Limitations include reliance on administrative data and lack of laboratory results. Overall, despite increased PCT testing, its role in bronchiolitis remains unclear, necessitating further research to optimize its use. (AI-generated)
The jury is still out on the utility of procalcitonin use in bronchiolitis
Procalcitonin was initially intended for use predicting bacteremia in adults with community-acquired pneumonia and has recently been applied to the pediatric population somewhat broadly, especially in risk stratification of febrile neonates. The specificity of procalcitonin for use in bronchiolitis is not well known, and it’s unclear to me, and the authors, why the use of this laboratory test has increased so much in this population. Anecdotally, it seems procalcitonin is often ordered for patients who seem more ill than “average” or with an atypical clinical course, rather than a way to simply tease out bacterial or viral pneumonia and thus the need for antibiotics. Given that the increase in procalcitonin has not made a change in the prescription of antibiotics, it seems we need future studies to understand how clinicians are utilizing this information in order to inform an intervention to improve laboratory stewardship. In this study, the median standard unit cost of PCT was $76, not a small fee, particularly if the lab is repeated for trending. While I’d like to think I’m judicious about testing in bronchiolitis, I’ll be more conscientious moving forward in my own practice and education of learners.
Source
Hospital Variations and Temporal Trends in Procalcitonin Use for Patients With Bronchiolitis. Hosp Pediatr. 2024 Oct 1;14(10):806-814. doi: 10.1542/hpeds.2023-007631. PMID: 39290182
