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procalcitonin, sepsis, antimicrobial stewardship, intensive care, implementation science
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O'Sullivan R, Knight T, Horner D et al. Procalcitonin-guided antibiotic discontinuation after ADAPT-Sepsis: a national survey of current practice and readiness for implementation [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:155 (https://doi.org/10.3310/nihropenres.14461.1)
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Research Note
Procalcitonin-guided antibiotic discontinuation after ADAPT-Sepsis: a national survey of current practice and readiness for implementation
[version 1; peer review: awaiting peer review]
PUBLISHED 13 Oct 2026
OPEN PEER REVIEW
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Abstract
Plain Language Summary
Corresponding author:
Richard O'Sullivan
Competing interests:
PD was the recipient of NIHR public funding as Chief Investigator of the Biomarker-guided duration of antibiotic treatment in hospitalised patients with moderate or severe sepsis (ADAPT-Sepsis) trial (NIHR128374). TF was the co-applicant of the NIHR grant, which funded the ADAPT-Sepsis trial.
Grant information:
JD and PW are funded by the NIHR Applied Research Collaboration Greater Manchester (NIHR209632). TF is funded by the NIHR HealthTech Research Centre in Emergency and Acute Care (NIHR205301). RO, PD, TF and JD are supported by the NIHR Manchester Biomedical Research Centre (NIHR203308). DH is funded through an NIHR Senior Clinical Practitioner and Researcher Award (NIHR 304434). PD holds an NIHR Senior Investigator Award.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2026 O'Sullivan R et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: O'Sullivan R, Knight T, Horner D et al. Procalcitonin-guided antibiotic discontinuation after ADAPT-Sepsis: a national survey of current practice and readiness for implementation [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:155 (https://doi.org/10.3310/nihropenres.14461.1)
First published: 13 Oct 2026, 6:155 (https://doi.org/10.3310/nihropenres.14461.1)
Latest published: 13 Oct 2026, 6:155 (https://doi.org/10.3310/nihropenres.14461.1)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Introduction
ADAPT-Sepsis demonstrated that procalcitonin (PCT)-guided care safely reduced antibiotic duration in ICU patients treated for sepsis.1 Subsequent meta-analysis supports reductions in antibiotic exposure with no increase in mortality,2 and economic evaluations suggest PCT-guided care may be cost-effective.3 International guidelines now suggest using PCT alongside clinical assessment to support antibiotic discontinuation decisions,4 while updated NICE guidance is awaited.5
Despite this, UK implementation remains uncertain. In a 2018 survey, almost 75% of UK clinicians reported rarely or never using PCT,6 although subsequent qualitative work found broadly positive views towards PCT-guided antimicrobial stewardship.7,8 Following publication of ADAPT-Sepsis, we surveyed current UK practice relating to PCT-guided antibiotic discontinuation and explored clinician and organisational readiness for routine adoption of this.
Methods
Patient and public involvement
Patients and the public were not involved in the design, conduct, choice of outcome measures, recruitment or reporting of this study, which surveyed healthcare professionals about their current practice and readiness to implement the findings from ADAPT-Sepsis.
Consent
Participants received study information on the survey's opening page; by completing the questionnaire, consent was implied.
Ethics
Formal ethical review was not required. The NHS Health Research Authority and University of Manchester research ethics decision tools both indicated that this anonymous survey of healthcare professionals, on matters within their professional competence, fell outside the scope of review.
Survey design
An anonymous electronic survey (via Qualtrics, hosted by The University of Manchester) was distributed via professional mailing lists (Intensive Care Society, UK) between March and June 2025. Questions explored current use of PCT and CRP in sepsis, local stopping protocols, and readiness to implement PCT-guided antibiotic discontinuation (full survey available).9 Organisational readiness was assessed using the Organisational Readiness for Implementing Change (ORIC) instrument.10 Analyses were performed using complete available responses, missing responses were excluded and not imputed. All questions were optional and survey data was handled and stored in line with the University of Manchester data protection and confidentiality policies. Reporting is guided by the Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist.9,11
Results
Respondent characteristics
Ninety-nine survey responses were received, of which 13 were excluded (either blank or contained only geographical information with no further answers). Eighty-six respondents from 30 UK healthcare organisations were therefore included in the analysis. Most respondents worked in intensive care (87%), were doctors (69%) or pharmacists (19%), and were based in England (81%) ( Table 1 and Table 2).
Table 1. Demographic and professional characteristics of survey respondents.
| N = 861 | |
|---|---|
| Current role | |
| Doctor | 59 (69%) |
| Pharmacist | 16 (19%) |
| Nurse | 4 (4.7%) |
| ACCP | 3 (3.5%) |
| Other | 4 (4.7%) |
| Doctor grade | |
| Consultant | 47 (80%) |
| Resident | 10 (17%) |
| SAS doctor | 1 (1.7%) |
| Other | 1 (1.7%) |
| Main area of practice | |
| Intensive care | 75 (87%) |
| Anaesthesia | 2 (2.3%) |
| Medicine | 2 (2.3%) |
| Emergency medicine | 1 (1.2%) |
| Other | 6 (7.0%) |
| Hospital type | |
| Teaching Hospital | 48 (56%) |
| District General Hospital | 35 (41%) |
| Other | 3 (3.5%) |
Table 2. Patient populations treated within respondents' intensive care units.
Percentages are calculated using the total number of respondents as the denominator (N = 86). Respondents could select more than one option.
| ICU specialties | N = 861 |
|---|---|
| Medical | 79 (91.9%) |
| Surgical | 76 (88.4%) |
| Trauma | 50 (58.1%) |
| Vascular | 41 (47.7%) |
| UGI surgery | 39 (45.3%) |
| Neurosciences | 30 (34.9%) |
| Burns | 19 (22.1%) |
| Thoracic | 19 (22.1%) |
| Transplant | 18 (20.9%) |
| Other | 12 (14.0%) |
| Cardiac surgical | 10 (11.6%) |
| Missing | 1 (1.2%) |
Current PCT practice
Almost half of respondents reported measuring PCT occasionally in selected patients (42/85, 49%) ( Table 3). Daily measurement in every patient was reported by 4/85 respondents (4.7%), with a further 4/85 (4.7%) reporting daily measurement in selected patients only. Overall, 24/85 respondents (28%) reported rarely or never measuring PCT. By contrast, most respondents reported measuring CRP daily in every patient (46/86, 53%). PCT was usually reported to be a special request rather than part of a routine blood test panel ( Table 3).
Table 3. Patterns of PCT and CRP measurement, and methods of requesting PCT, stratified by hospital type.
Most respondents (51/73, 70%) reported that their service had no agreed protocol using defined PCT thresholds to guide antibiotic discontinuation in sepsis ( Table 4). Nearly half reported wishing to increase their use of PCT thresholds to guide discontinuation (36/73, 49%), while 21/73 (29%) were uncertain and wanted further information. Only 2/73 (2.7%) reported wishing to decrease their use of PCT thresholds in this context ( Table 4).
Table 4. Use of PCT and CRP thresholds to stop antibiotics, and attitudes to future use.
| Overall N = 861 | Teaching Hospital N = 481 | District General Hospital N = 351 | Other N = 31 | |
|---|---|---|---|---|
| CRP threshold used to stop | ||||
|  Yes | 2 (2.5%) | 1 (2.1%) | 1 (3.1%) | 0 (0%) |
|  No | 77 (95%) | 46 (98%) | 29 (91%) | 2 (100%) |
|  Don't know | 2 (2.5%) | 0 (0%) | 2 (6.3%) | 0 (0%) |
|  Missing | 5 | 1 | 3 | 1 |
| PCT threshold used to stop | ||||
|  Yes | 22 (30%) | 12 (29%) | 10 (34%) | 0 (0%) |
|  No | 51 (70%) | 30 (71%) | 19 (66%) | 2 (100%) |
|  Don't know | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
|  Missing | 13 | 6 | 6 | 1 |
| Desire to change use of PCT thresholds to STOP antibiotics | ||||
|  Yes, increase my use of PCT measurement in this context | 36 (49%) | 22 (51%) | 13 (46%) | 1 (50%) |
|  No, stay the same | 10 (14%) | 5 (12%) | 5 (18%) | 0 (0%) |
|  I am not sure, I need more information to decide | 21 (29%) | 10 (23%) | 10 (36%) | 1 (50%) |
|  Yes, decrease my use of PCT measurement in this context | 2 (2.7%) | 2 (4.7%) | 0 (0%) | 0 (0%) |
|  Other | 4 (5.5%) | 4 (9.3%) | 0 (0%) | 0 (0%) |
|  Missing | 13 | 5 | 7 | 1 |
Readiness for implementation of PCT-guided antibiotic discontinuation in sepsis
60/86 respondents (69.8%) completed all 12 ORIC items ( Figure 1). On a five-point scale, the mean overall ORIC score was 3.42 (SD 1.03), with mean change commitment and change efficacy scores of 3.31 (SD 1.06) and 3.50 (SD 1.05), respectively, indicating favourable readiness.
Figure 1. Respondent perceptions of readiness to implement PCT-guided antibiotic discontinuation.
Organisational Readiness for Implementing Change (ORIC) is a validated measure of an organisation's readiness to implement a new intervention, comprising two domains: change commitment (the shared willingness to implement the change) and change efficacy (the shared belief that the organisation has the capability to implement it successfully). Data include the 60/86 survey respondents who completed all 12 ORIC items in full.
Discussion
To our knowledge, this is the first national survey of UK practice and organisational readiness for PCT-guided antibiotic discontinuation after ADAPT-Sepsis.1 Data were collected shortly after ADAPT-Sepsis and before publication of the subsequent systematic review and meta-analysis, capturing practice early in evidence translation.
Compared with a 2018 survey of 380 NHS healthcare professionals, fewer respondents reported ‘rarely or never’ using PCT, falling from 73.8% to 28%, suggesting increased use over time.6 However, consistent with the previous survey, PCT was still usually measured selectively rather than routinely, and agreed stopping protocols were uncommon. Together, these data suggest variable practice and limited routine protocolised use.
Nearly half wished to increase their use of PCT thresholds to guide antibiotic discontinuation, whilst almost a third wanted more information. Previously identified enablers include clear guidance, local protocol and further education which may support translation of recent trial evidence into routine care.2,8
This study is subject to several limitations. Participation was voluntary and therefore susceptible to selection bias, multiple responses may have come from individual respondents or hospital sites, and respondents’ familiarity with ADAPT-Sepsis was not accurately assessed. The denominator of clinicians who had access to the survey (and therefore the response rate) is unknown. Furthermore, the survey was conducted in 2025 and preceded publication of a systematic review showing no increase in mortality with PCT-guided care.2 Clinician views may have changed in light of this new evidence.
In conclusion, whilst PCT-guided antibiotic discontinuation can safely reduce antibiotic duration in patients with sepsis, current use is unlikely to be routine. Insights here suggest health professionals are open to increased use of PCT-guided discontinuation. However, the ORIC scores for implementation of this innovation, whilst favourable, do not indicate strong readiness on the part of individuals or organisations. Further adoption and spread will need active support to bridge the challenging journey from research to practice. Barriers to implementation must be identified and addressed and approaches that facilitate implementation activated. Only with such translational support will the benefits identified by research impact patient care.
Statement on the use of generative AI tools
Microsoft 365 Copilot (GPT-5) and Anthropic Claude (Opus 5) were used to assist with proofreading and to suggest wording changes for clarity. The tools were not used to generate data, perform analyses, or draw conclusions. All data synthesis and analysis were performed by the authors, who take full responsibility for the content of this manuscript.
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O'Sullivan R, Knight T, Horner D et al. Procalcitonin-guided antibiotic discontinuation after ADAPT-Sepsis: a national survey of current practice and readiness for implementation [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:155 (https://doi.org/10.3310/nihropenres.14461.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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