Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting


Cathy Koetting

Jennifer Vines

Julie Lewis


Problem: The overuse of antibiotics has created antimicrobial resistance (AMR)

resulting in treatment failure for bacterial infections. To combat AMR, clinicians should

only prescribe antibiotic therapy when clinically warranted. It is easy to misdiagnose a

viral infection. However, any delay in the initiation of antibiotic therapy in a bacterial

infection may lead to increased morbidity and mortality. These patients with non-specific

clinical symptoms may be misdiagnosed without a rapid and definitive diagnostic test.

Methods: This quality improvement (QI) initiative utilized an evidence-based clinical

guideline for procalcitonin (PCT) levels for antibiotic therapy de-escalation. WBC counts

were collected two-days and one-day before ID work-up along with PCT levels and white

blood cell (WBC) counts collected on day-1, day-3, and day-5 post infectious disease.

Data was collected via prospective chart review including the number of positive PCT

levels obtained versus positive cultures, average length of antibiotic use, number of

different antibiotics used, and the time until the bacterial infection was confirmed or


Results: The implemented PCT clinical guideline allowed for faster identification of

bacterial infections than standard blood cultures. There is significant evidence supporting

a positive relationship between elevated PCT levels and positive cultures. Over time the

level of PCT decreases showing a correlation with a reduction of the WBC count.

Implications for Practice: Use of the PCT clinical guideline can identify whether there

is a bacterial infection rapidly allowing for the initiation or de-escalation of antibiotic

therapy preventing further AMR resistance.