4.6 Article

Procalcitonin to Guide Antibacterial Prescribing in Patients Hospitalised with COVID-19

期刊

ANTIBIOTICS-BASEL
卷 10, 期 9, 页码 -

出版社

MDPI
DOI: 10.3390/antibiotics10091119

关键词

procalcitonin; COVID-19; antimicrobial stewardship; bacterial co-infection

资金

  1. National Institute of Health Research (NIHR)
  2. Imperial Biomedical Research Centre (BRC)
  3. National Institute for Health Research Health Protection Research Unit (HPRU), in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London
  4. Public Health England

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This study explores the potential role of PCT in excluding bacterial co-infection in COVID-19 patients. A negative PCT result is associated with shorter antimicrobial courses, early cessation of therapy, and a lower frequency of ICU admission.
Antibacterial prescribing in patients presenting with COVID-19 remains discordant to rates of bacterial co-infection. Implementing diagnostic tests to exclude bacterial infection may aid reduction in antibacterial prescribing. (1) Method: A retrospective observational analysis was undertaken of all hospitalised patients with COVID-19 across a single-site NHS acute Trust (London, UK) from 1 December 2020 to 28 February 2021. Electronic patient records were used to identify patients, clinical data, and outcomes. Procalcitonin (PCT) serum assays, where available on admission, were analysed against electronic prescribing records for antibacterial prescribing to determine relationships with a negative PCT result (<25 mg/L) and antibacterial course length. (2) Results: Antibacterial agents were initiated on admission in 310/624 (49.7%) of patients presenting with COVID-19. A total of 33/74 (44.5%) patients with a negative PCT on admission had their treatment stopped within 24 h. A total of 6/49 (12.2%) patients were started on antibacterials, but a positive PCT saw their treatment stopped. Microbiologically confirmed bacterial infection was low (19/594; 3.2%) and no correlation was seen between PCT and culture positivity (p = 1). Lower mortality (15.6% vs. 31.4%; p = 0.049), length of hospital stay (7.9 days vs. 10.1 days; p = 0.044), and intensive care unit (ICU) admission (13.9% vs. 40.8%; p = 0.001) was noted among patients with low PCT. (3) Conclusions: This retrospective analysis of community acquired COVID-19 patients demonstrates the potential role of PCT in excluding bacterial co-infection. A negative PCT on admission correlates with shorter antimicrobial courses, early cessation of therapy, and predicts lower frequency of ICU admission. Low PCT may support decision making in cessation of antibacterials at the 48-72 h review.

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