Procalcitonin to guide antibacterial prescribing in patients hospitalised with COVID-19
File(s)
Published version
Author(s)
Hughes, Stephen
Mughal, Nabeela
Moore, Luke
Type
Journal Article
Abstract
Abstract: 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 un-dertaken of all hospitalised patients with COVID-19 across a single-site NHS acute Trust (London, UK) from 01/12/20–28/2/21. 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 (<0.25 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. 33/74 (44.5%) patients with a negative PCT on admission had their treatment stopped within 24 h. 6/49 (12.2%) patients who had antibacterials started but a positive PCT had their treatment stopped. Microbiologically confirmed bacterial infection was low (19/594; 3.2%); no correlation was seen with 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) were seen among patients with low PCT. (3) Conclusion: This retrospective analysis of community acquired COVID-19 patients demonstrates the potential role of PCT in ex-cluding 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.
Date Issued
2021-09-17
Date Acceptance
2021-09-14
Citation
Antibiotics, 2021, 10, pp.1-8
ISSN
2079-6382
Publisher
MDPI AG
Start Page
1
End Page
8
Journal / Book Title
Antibiotics
Volume
10
Copyright Statement
© 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.mdpi.com/2079-6382/10/9/1119
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Pharmacology & Pharmacy
procalcitonin
COVID-19
antimicrobial stewardship
bacterial co-infection
COVID-19
antimicrobial stewardship
bacterial co-infection
procalcitonin
Publication Status
Published
Article Number
1365231
Date Publish Online
2021-09-17