Doctor of Nursing Practice
Date of Defense
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.
Kile, Briana, "Initiation of Procalcitonin Screening as a Marker in Antibiotic Therapy De-escalation" (2022). Dissertations. 1210.