{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:15:05Z","timestamp":1788999305456,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Appropriate test utilization strategies are paramount in preventing the overuse of antibiotics, which can contribute to antimicrobial resistance. Biomarkers such as procalcitonin (PCT) are frequently ordered upon suspicion of infection, but current pneumonia and sepsis guidelines recommend against using PCT alone when initiating antibiotic therapy. The purpose of this study was to evaluate the effectiveness of standardized, guideline-based computerized decision support in curbing the inappropriate ordering of PCT testing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study was a retrospective, single-center cohort of hospitalized adult patients with at least 1 available PCT serum level over a 27-month period. Secondary outcomes included the total number of PCT orders, the number of days on antibiotics, and the appropriate antibiotic response rate based on the PCT result.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 300 patients met our inclusion criteria for this study. The rate of appropriate PCT ordering increased in the postimplementation group (2% vs 10%), with an increased rate of appropriate ordering in patients with community-acquired pneumonia (4.3% vs 18.4%) and no change in patients with sepsis (0% vs 3.3%). Overall, PCT orders dropped by 78% after implementation of decision support.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This study demonstrated that the addition of guideline-based computerized clinical decision support increased the rate of diagnostic stewardship for PCT orders.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/labmed\/lmae108","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T16:24:41Z","timestamp":1741105481000},"page":"396-401","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic stewardship of procalcitonin testing by implementation of computer-based decision support"],"prefix":"10.1093","volume":"56","author":[{"given":"Gina M","family":"Belfiore","sequence":"first","affiliation":[{"name":"Department of Pharmacy, University of Florida Health Jacksonville , Jacksonville, FL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A","family":"Jankowski","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Florida Health Jacksonville , Jacksonville, FL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen L","family":"Isache","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Disease, University of Florida Health Jacksonville , Jacksonville, FL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Florida Health Jacksonville , Jacksonville, FL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Feldhammer","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Florida Health Jacksonville , Jacksonville, FL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"2025071202514150800_CIT0001","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1093\/cid\/ciab672","article-title":"Advancing diagnostic stewardship for healthcare-associated infections, antibiotic resistance, and sepsis","volume":"74","author":"Curren","year":"2022","journal-title":"Clin Infect Dis."},{"key":"2025071202514150800_CIT0002","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1097\/CCM.0B013E318165BABB","article-title":"Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations","volume":"36","author":"Becker","year":"2008","journal-title":"Crit Care Med."},{"key":"2025071202514150800_CIT0003","doi-asserted-by":"publisher","first-page":"610","DOI":"10.21037\/atm-20-1855","article-title":"A 2020 review on the role of procalcitonin in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine","volume":"8","author":"Azzini","year":"2020","journal-title":"Ann Transl Med"},{"key":"2025071202514150800_CIT0004","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1001\/jama.2009.1297","article-title":"Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial","volume":"302","author":"Schuetz","year":"2009","journal-title":"JAMA."},{"key":"2025071202514150800_CIT0005","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1056\/NEJMoa1802670","article-title":"Procalcitonin-Guided use of antibiotics for lower respiratory tract infection","volume":"379","author":"Huang","year":"2018","journal-title":"N Engl J Med."},{"key":"2025071202514150800_CIT0006","doi-asserted-by":"publisher","first-page":"CD007498","DOI":"10.1002\/14651858.CD007498.pub3","article-title":"Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections","volume":"10","author":"Schuetz","year":"2017","journal-title":"Cochrane Database Syst Rev."},{"key":"2025071202514150800_CIT0007","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1007\/s00134-018-5141-9","article-title":"Procalcitonin algorithm to guide initial antibiotic therapy in acute exacerbations of COPD admitted to the ICU: a randomized multicenter study","volume":"44","author":"Daubin","year":"2018","journal-title":"Intensive Care Med."},{"key":"2025071202514150800_CIT0008","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1016\/j.chest.2018.12.029","article-title":"Procalcitonin-guided antibiotic discontinuation and mortality in critically Ill adults: a systematic review and meta-analysis","volume":"155","author":"Pepper","year":"2019","journal-title":"Chest."},{"key":"2025071202514150800_CIT0009","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.21037\/jtd.2019.11.63","article-title":"Role of procalcitonin use in the management of sepsis","volume":"12","author":"Gregoriano","year":"2020","journal-title":"J Thorac Dis"},{"key":"2025071202514150800_CIT0010","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1097\/CCM.0000000000002928","article-title":"Efficacy and safety of procalcitonin guidance in patients with suspected or confirmed sepsis: a systematic review and meta-analysis","volume":"46","author":"Iankova","year":"2018","journal-title":"Crit Care Med."},{"key":"2025071202514150800_CIT0011","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1016\/j.cmi.2018.05.011","article-title":"Procalcitonin-guided antibiotic therapy in patients with fever in a general emergency department population: a multicentre non-inferiority randomized clinical trial (HiTEMP study)","volume":"24","author":"van der Does","year":"2018","journal-title":"Clin Microbiol Infect."},{"key":"2025071202514150800_CIT0012","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s13643-023-02432-w","article-title":"Accuracy of procalcitonin for diagnosing sepsis in adult patients admitted to the emergency department: a systematic review and meta-analysis","volume":"13","author":"Zaki","year":"2024","journal-title":"Syst Rev."},{"key":"2025071202514150800_CIT0013","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/S1473-3099(16)00053-0","article-title":"Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial","volume":"16","author":"de Jong","year":"2016","journal-title":"Lancet Infect Dis."},{"key":"2025071202514150800_CIT0014","doi-asserted-by":"publisher","first-page":"944","DOI":"10.3111\/13696998.2015.1064934","article-title":"A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis","volume":"18","author":"Kip","year":"2015","journal-title":"J Med Econ"},{"key":"2025071202514150800_CIT0015","doi-asserted-by":"publisher","first-page":"ofw249","DOI":"10.1093\/ofid\/ofw249","article-title":"Using procalcitonin to guide antibiotic therapy","volume":"4","author":"Rhee","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2025071202514150800_CIT0016","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1001\/jama.2019.21118","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia","volume":"323","author":"Olson","year":"2020","journal-title":"JAMA."},{"key":"2025071202514150800_CIT0017","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/S2213-2600(23)00461-7","article-title":"GOLD COPD report: 2024 update","volume":"12","author":"Venkatesan","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2025071202514150800_CIT0018","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"2025071202514150800_CIT0019","doi-asserted-by":"publisher","first-page":"ofaa096","DOI":"10.1093\/ofid\/ofaa096","article-title":"Low sensitivity of procalcitonin for bacteremia at an academic medical center: a cautionary tale for antimicrobial stewardship","volume":"7","author":"Goodlet","year":"2020","journal-title":"Open Forum Infect Dis."},{"key":"2025071202514150800_CIT0020","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.cmi.2014.12.026","article-title":"The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis","volume":"21","author":"Hoeboer","year":"2015","journal-title":"Clin Microbiol Infect."},{"key":"2025071202514150800_CIT0021","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1111\/ijcp.12474","article-title":"Procalcitonin fails to predict bacteremia in SIRS patients: a cohort study","volume":"68","author":"Hoenigl","year":"2014","journal-title":"Int J Clin Pract."},{"key":"2025071202514150800_CIT0022","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1093\/cid\/ciz545","article-title":"Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis","volume":"70","author":"Kamat","year":"2020","journal-title":"Clin Infect Dis."},{"key":"2025071202514150800_CIT0023","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1093\/cid\/cix179","article-title":"Practice patterns and outcomes associated with procalcitonin use in critically Ill patients with sepsis","volume":"64","author":"Chu","year":"2017","journal-title":"Clin Infect Dis."},{"key":"2025071202514150800_CIT0024","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/S1473-3099(07)70052-X","article-title":"Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis","volume":"7","author":"Tang","year":"2007","journal-title":"Lancet Infect Dis."},{"key":"2025071202514150800_CIT0025","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/S1473-3099(12)70323-7","article-title":"Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis","volume":"13","author":"Wacker","year":"2013","journal-title":"Lancet Infect Dis."},{"key":"2025071202514150800_CIT0026","doi-asserted-by":"publisher","first-page":"223","DOI":"10.11613\/BM.2014.025","article-title":"The laboratory test utilization management toolbox","volume":"24","author":"Baird","year":"2014","journal-title":"Biochem Med (Zagreb)"}],"container-title":["Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/labmed\/article-pdf\/56\/4\/396\/62198799\/lmae108.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/labmed\/article-pdf\/56\/4\/396\/62198799\/lmae108.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T06:51:46Z","timestamp":1752303106000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/labmed\/article\/56\/4\/396\/8045434"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2,27]]},"published-print":{"date-parts":[[2025,7,11]]}},"URL":"https:\/\/doi.org\/10.1093\/labmed\/lmae108","relation":{},"ISSN":["0007-5027","1943-7730"],"issn-type":[{"value":"0007-5027","type":"print"},{"value":"1943-7730","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,2,27]]}}}