A recent study has investigated whether introducing an extra blood test known as procalcitonin (PCT) could effectively shorten the duration that children need to stay on intravenous (IV) antibiotics in hospitals. While earlier analyses were hopeful, this study revealed that relying on the PCT biomarker to make treatment choices did not lead to a decrease in the length of antibiotic therapy when compared to standard care.
In a pioneering study from the UK, spearheaded by the University of Liverpool, researchers explored if an additional blood test called procalcitonin (PCT) could safely reduce the time children spend on intravenous (IV) antibiotics in hospital settings.
Despite previous analyses showing promise, this research, which received funding from the National Institute for Health and Care Research (NIHR), concluded that utilizing the PCT biomarker to guide treatment did not significantly lower the duration of antibiotic therapy compared to traditional care approaches.
The findings were published in the Lancet Child & Adolescent Health and are part of the ‘Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection’ (BATCH) trial. This national research initiative aims to combat antibiotic misuse among hospitalized children and mitigate the spread of antimicrobial resistance (AMR).
Antibiotic overuse is a major contributor to AMR, which poses one of the most significant public health threats globally. Infections from resistant bacteria can lead to extended hospital stays, escalated healthcare expenses, and higher mortality rates. Children are particularly at risk, making it vital to use antibiotics wisely to ensure their health in the future.
This study involved close to 2,000 children, aged from 72 hours to 18 years, who were suspected of having bacterial infections across 15 hospitals.
Researchers observed that including the PCT test in standard care did not lessen the duration of IV antibiotic therapy. Although the test proved to be safe, it was more expensive than conventional methods, and healthcare teams faced issues when attempting to integrate the test into their decision-making processes.
The study follows a systematic review and cost-effectiveness analysis by NICE in 2015, which assessed PCT testing to guide antibiotic treatment for sepsis and encouraged further investigations to accurately evaluate the effectiveness of incorporating PCT algorithms in guiding antibiotic treatment among hospitalized adults and children with serious bacterial infections.
The findings illustrate that merely introducing new tools like PCT testing is not sufficient. Successful implementation necessitates:
- Comprehensive Antimicrobial Stewardship (AMS) programs: Several hospitals now employ AMS strategies to ensure responsible antibiotic prescriptions and minimize unnecessary use.
- Education and training for Clinicians: Familiarity with innovative tests and confidence in interpreting their results are essential for success.
- Research on implementation: Future studies should focus on identifying obstacles and facilitators to enhance the faithful application of the intervention.
- Behavioral Change: Gaining a deeper understanding of the intricate factors that affect whether and how clinicians act on diagnostic test information for making antibiotic prescribing choices will improve the adherence to trial interventions and help incorporate effective tests.
The results highlight the need for continued investment in AMS programs and public health efforts to curb antibiotic misuse. The researchers acknowledge that while the PCT-guided approach did not show significant benefits in this trial, it might still hold promise in particular contexts with further improvements. As the UK moves forward with its Five-Year Antimicrobial Resistance Strategy, this research offers crucial insights into the challenges of applying new diagnostic tests in hospital settings.
Professor Enitan Carrol, the chief investigator from the University of Liverpool, stated: “We are proud to have completed this extensive multi-centre trial involving hospitalized children. Although the study did not show any advantages from using the additional procalcitonin test, there are essential lessons for future biomarker-led trials within the NHS.”
“The BATCH study was a pragmatic evaluation to see if the intervention is effective in real-world situations where clinicians are not bound by strict diagnostic algorithms for antibiotic cessation. Our study displayed low adherence to the algorithm, and challenges integrating the test into standard clinical workflows were evident. This study emphasizes the significance of incorporating behavior change and implementation frameworks into pragmatic trial designs.”
Dr. Emma Thomas-Jones, Principal Research Fellow and Deputy Director of Infection, Inflammation & Immunity Trials at the Cardiff Centre for Trials Research, remarked: “Research plays a critical role in enhancing the management of serious bacterial infections, such as sepsis. It has been a privilege to collaborate with Professor Carrol on this important trial, demonstrating the effective contributions of the multidisciplinary team involved in these results, which will provide clear evidence regarding the use of procalcitonin as a biomarker for guiding clinical decisions concerning antibiotic discontinuation in children with serious bacterial infections.”
The BATCH trial was carried out by prominent UK universities and hospitals including the University of Liverpool, Liverpool School of Tropical Medicine, Alder Hey Children’s NHS Foundation Trust, the Centre for Trials Research at Cardiff University, the University of Southampton, Lancaster University, Sheffield Children’s NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust, Bristol Royal Hospital for Children, University Hospital Southampton NHS Foundation Trust, and Hull York Medical School.
This is the largest trial of its nature evaluating PCT-guided antibiotic treatment in pediatric patients.
