Clinical Efficacy and Economic Evaluation of Dynamic Procalcitonin (PCT) Monitoring in Guiding Antibiotic Course Management for Sepsis

Abstract

To evaluate the clinical efficacy and health economic value of procalcitonin (PCT)-guided antibiotic discontinuation based on dynamic monitoring in ICU patients with sepsis. A prospective cohort study was conducted involving 180 sepsis patients admitted to our ICU from January 2023 to June 2024. Patients were divided into a PCT-guided group (n=90) and a conventional therapy group (n=90). In the PCT-guided group, antibiotic discontinuation was considered when the daily monitored serum PCT level fell below 0.25 ng/mL and had decreased by ≥80% from its peak, combined with clinical assessment. The conventional group followed standard clinical practice based on experience, imaging, and traditional lab markers. Outcomes including 28-day all-cause mortality, antibiotic duration, ICU and total hospital length of stay (LOS), total medical costs, incidence of antibiotic-associated adverse events, and microbiological resistance profiles were compared. No significant difference was found in 28-day mortality between the PCT-guided and conventional groups (22.2% vs. 25.6%, P>0.05). The PCT-guided group showed significantly shorter antibiotic duration [(8.5±3.2) vs. (12.1±4.5) days], ICU LOS [(10.3±4.1) vs. (13.8±5.2) days], and total hospital LOS [(18.6±6.8) vs. (22.4±7.9) days] (all P<0.01). Total medical costs were significantly lower in the PCT-guided group [(15.3±5.2) vs. (18.9±6.1) ten thousand CNY, P<0.01], primarily due to savings in antibiotic costs and ICU-related expenses. The incidence of antibiotic-associated diarrhea (including C. difficile infection) was significantly lower in the PCT-guided group (5.6% vs. 13.3%, P<0.05).