New research finds that PCT (procalcitonin) blood test does not lower antibiotic treatment duration for hospitalised children.
A study led by the University of Liverpool, in collaboration with Cardiff University's Centre of Clinical Trials Research, has found that despite previous promising analysis, a blood test used to diagnose infection and sepsis did not reduce the time children spend on intravenous antibiotics in hospitals.
Antimicrobial resistance is one of the biggest challenges of our time - and reducing antibiotic overuse is a vital part in tackling antimicrobial resistance. As well as global impacts, this is also a problem that impacts the lives of patients - as infections caused by resistant bacteria cause longer hospital stays and increase mortality. Acting as antibiotic guardians is essential for the future health of individual patients, as well as tackling this global challenge.
This study investigated the role of procalcitonin tests (PCT tests), which helps to diagnose infections and sepsis, in reducing the time spent on antibiotics in hospitals. The clinical trials were conducted across 15 hospitals and enrolled nearly 2,000 children aged between 72 hours and 18 years with suspected bacterial infections.
The study is part of the 'Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection' (BATCH) trial - a national research trial to tackle antibiotic overuse in hospitalised children and reduce the spread of antimicrobial resistance.
The researchers found that adding the PCT test to routine care did not reduce the duration of IV antibiotic use. The test was safe but costlier than standard methods, and healthcare teams faced challenges integrating it into their decision-making processes.
The study comes after a systematic review and cost-effectiveness analysis conducted by NICE in 2015, which evaluated PCT testing to guide antibiotic therapy for the treatment of sepsis, and recommended further studies to adequately assess the effectiveness of adding PCT algorithms to guide antibiotic treatment in hospitalised adults and children with suspected or confirmed serious bacterial infection.
The results highlight that introducing new tools like PCT tests alone isn't enough. The results recommended that hospitals implement Antimicrobial Stewardship (AMS) programmes, training and education for clinicians, behavioural changes, and further studies.
Professor Enitan Carrol, Chief investigator the University of Liverpool, said: "Whilst the study did not demonstrate benefit from the additional procalcitonin test, there is important learning for future biomarker-guided trials in the NHS.
"The BATCH study was a pragmatic trial evaluating if the intervention works under real-world conditions where clinicians do not have to adhere to diagnostic algorithms about antibiotic discontinuation. Adherence to the algorithm was low in our study, and there were challenges in integrating the test into routine clinical workflows. The study highlights the importance of including behaviour change and implementation frameworks into pragmatic trial designs."
Research is vital to improving the management of serious bacterial infections, like sepsis. This important trial will make a real difference, providing clear evidence on the use of procalcitonin as a biomarker in guiding clinical decision-making about antibiotic discontinuation in children with serious bacterial infections.
The BATCH trial was funded by the National Institute for Health and Care Research (NIHR) and conducted by leading 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 and Lancaster University, Sheffield Children's NHS Foundation Trust, Oxford University Hospitals NHS Foundation, Bristol Royal Hospital for Children, University Hospital Southampton NHS Foundation Trust and Hull York Medical School.
