Major UK Study Debunks Procalcitonin Blood Test's Potential to Cut Antibiotic Duration in Hospitalized Children

A significant study from the UK, involving researchers from Lancaster University, has put to rest the hope that a procalcitonin (PCT) blood test could help reduce the time children spend on intravenous (IV) antibiotics while hospitalized. This extensive trial, published in The Lancet, is the largest of its kind focused on PCT-guided antibiotic treatment for children.

Despite promising indications from earlier analyses, the study revealed that integrating the PCT biomarker into treatment protocols did not result in shorter antibiotic treatment durations compared to standard care. This initiative forms part of the ‘Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection’ (BATCH) trial, aimed at tackling the urgent issue of antibiotic overuse and mitigating the threat of antimicrobial resistance (AMR).

Antibiotic overuse is a leading factor in the rise of AMR, one of the most pressing public health challenges worldwide. AMR is known for prolonging hospital stays, escalating healthcare costs, and increasing patient mortality rates, particularly affecting vulnerable populations like children. Therefore, optimized antibiotic management is crucial for safeguarding the future health of younger generations.

The BATCH trial was supported by the National Institute for Health and Care Research (NIHR) and included participation from top UK hospitals and universities, such as the University of Liverpool and Alder Hey Children’s NHS Foundation Trust, conducting research across 15 hospitals with nearly 2,000 children aged 72 hours to 18 years exhibiting suspected bacterial infections.

Findings indicated that while the PCT test is safe, its cost burden, along with challenges in incorporating it into clinical decision-making, overshadowed any potential advantages. Professor Céu Mateus from Lancaster University remarked on the importance of this research in enhancing healthcare delivery and resource management within hospitals.

An earlier review by the National Institute for Health and Care Excellence (NICE) in 2015 acknowledged the need for further studies on the effectiveness of PCT tests for sepsis management, underlining the significance of ongoing research in this area.

The results highlight that merely introducing new diagnostic tools like PCT is insufficient for improving antibiotic prescribing practices. Successful implementation demands several essential components: 1. Strong Antimicrobial Stewardship (AMS) Programs: Many healthcare facilities are already adopting AMS to encourage responsible antibiotic dispensing habits. 2. Education and Training for Clinicians: Ensuring that healthcare professionals are well-acquainted with new tests and adept at understanding their results is vital for effective deployment. 3. Research on Implementation: Future inquiries must focus on identifying barriers to successful integration of new tests to enhance their utilization. 4. Understanding Behavior Change: Gaining insight into the behavioral factors that influence clinicians' prescribing decisions can bolster adherence to diagnostic results, thereby optimizing antibiotic usage.

Despite the BATCH trial’s findings questioning the role of PCT-guided treatment in general, the potential for these tests in particular contexts remains open for future investigation, especially as the UK advances in its Five-Year Antimicrobial Resistance Strategy. This research sheds light on the complexities involved in assimilating new diagnostic tools into existing clinical frameworks.

Professor Enitan Carroll from the University of Liverpool emphasizes the valuable lessons learned from this extensive multi-center trial, noting that while the PCT test did not exhibit clear benefits, it offers critical insights for future biomarker-guided studies within the NHS.

Dr. Emma Thomas-Jones, Principal Research Fellow and Deputy Director of Infection, Inflammation & Immunity Trials at the Cardiff Centre for Trials Research, also highlighted that ongoing research is paramount for enhancing the management of severe bacterial infections such as sepsis, reinforcing the overarching need for effective antibiotic stewardship and innovative research approaches in tackling AMR.