Observational studyBMJ open2024
Point-of-care tests, diagnostic uncertainty and antimicrobial stewardship in the ICU: procalcitonin or PCR to aid antibiotic-stop decisions - an observational cohort study.
Observational study in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The trial behind it
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Who cites it
4 citing papers in PubMed.
- Machine says go, doctor says no: an ecological momentary assessment analysis examining clinicians' perceptions of, and their antibiotic prescribing behaviour when using rapid molecular diagnostic tests in intensive care.Antimicrobial resistance and infection control · 2026Trial
- The Role and Importance of Procalcitonin (PCT) Testing in Rational Antibiotic Prescribing and Antibiotic Stewardship Programs.Immunity, inflammation and disease · 2026Review
- Infection point of care tests bridge the experience gap of antibiotic STOP decisions: clinicians versus students.The Journal of antimicrobial chemotherapy · 2026Observational
- Observational
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesIntensive care unit (ICU) clinicians stop antibiotics more often, with a negative infection: point-of-care test (PCR-POCT). Simulated cases of diagnostic uncertainty regarding infection resolution led clinicians to choose options such as procalcitonin (PCT) and/or PCR-POCTs +/- de-escalation to aid stop decisions. We hypothesised that a direct infection indicator, PCR-POCT, would influence stop judgements more than indirect PCT. Accordingly, we tested antibiotic-stop decisions when presented with a negative PCR-POCT despite borderline-positive PCT. DESIGNS: Observational prospective study.
settingICU.
participants66 ICU clinicians from University hospitals.
methodsClinicians saw four scenarios of different clinico-biological trajectories: (1) clear improvement, (2) clear worsening, (3) discordant-clinically better/biologically worse and (4) discordant-clinically worse/biologically better. Participants gave an initial decision (stop/continue/continue-escalate/continue-de-escalate). Then PCR-POCT and/or PCT was offered (accept/decline). After a negative PCR-POCT and borderline-positive PCT result, a final antibiotic decision was taken. MEASURES: Proportion of stop decisions before versus after test results per scenario. The association of the final decision with the clinician's change in confidence, willingness to request the biomarker(s) and the case trajectory was determined.
resultsFewer clinicians than expected stopped antibiotics versus baseline (36%, 94/264 vs 42%, 110/264, p=0.045). This was so in three of four scenarios, significantly less in the improvement (p<0.001) and the discordant clinically better scenario (p=0.024). PCT was requested more frequently than PCR-POCT (61% vs 53%, p<0.001). PCT requesters (vs declining) were significantly less inclined to stop antibiotics (p<0.001), while PCR-POCT requesting led to more stopping (p<0.001), before knowing the test results.
conclusionsA negative PCR-POCT result did not increase clinicians' inclination to stop antibiotics when alongside a borderline-positive PCT. This reflects clinicians' natural risk aversion. PCT was more popular than PCR-POCT, but PCR-POCT was more likely to aid stop decisions.Their comparison, role, utility and selective deployment for influencing antibiotic-stop decisions more effectively require a large randomised controlled trial.
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