Routine measurement of serum procalcitonin allows antibiotics to be safely withheld in patients admitted to hospital with SARS-CoV-2 infection

Williams, Emma J.; Mair, Luke; Silva, Thushan I. de; Green, D.J.; House, Philip J.; Cawthron, K.; Gillies, C.; Wigfull, J.; Parsons, Helena; Partridge, David G

doi:10.1101/2020.06.29.20136572

Cited by 6 publications

(5 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Others have recently reported its potential usefulness in limiting unnecessary antibiotic use in confirmed COVID-19. 20 Patients with probable or definite nosocomial COVID-19 had lower odds of receiving an antibiotic. It is possible these patients were diagnosed as part of a nosocomial outbreak and therefore bacterial infection was not suspected or alternatively symptoms were not severe compared to community onset infection which had necessitated admission.…”

Section: Discussionmentioning

confidence: 97%

Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals

Seaton

Gibbons

Cooper

et al. 2020

Journal of Infection

View full text Add to dashboard Cite

Background: Concern regarding bacterial co-infection complicating SARS-CoV-2 has created a challenge for antimicrobial stewardship. Following introduction of national antibiotic recommendations for suspected bacterial respiratory tract infection complicating COVID-19, a point prevalence survey of prescribing was conducted across acute hospitals in Scotland. Methods: Patients in designated COVID-19 units were included and demographic, clinical and antimicrobial data were collected from 15 hospitals on a single day between 20th and 30th April 2020. Comparisons were made between SARS-CoV-2 positive and negative patients and patients on non-critical care and critical care units. Factors associated with antibiotic prescribing in SARS-CoV-2 positive patients were examined using Univariable and multivariable regression analyses. Findings: There were 820 patients were included, 64.8% were SARS-CoV-2 positive and 14.9% were managed in critical care, and 22.1% of SARS-CoV-2 infections were considered probable or definite nosocomial infections. On the survey day, antibiotic prevalence was 45.0% and 73.9% were prescribed for suspected respiratory tract infection. Amoxicillin, doxycycline and co-amoxiclav accounted for over half of all antibiotics in non-critical care wards and meropenem, piperacillin-tazobactam and co-amoxiclav accounted for approximately half prescribed in critical care. Of all SARS-CoV-2 patients, 38.3% were prescribed antibiotics. In a multivariable logistic regression analysis, COPD/chronic lung disease and CRP ≥ 100 mg/l were associated with higher odds and probable or confirmed nosocomial COVID-19, diabetes and management on an elderly care ward had lower odds of an antibiotic prescription. Systemic antifungals were prescribed in 9.8% of critical care patients and commenced a median of 18 days after critical care admission. Interpretation: A relatively low prevalence of antibiotic prescribing in SARS-CoV-2 hospitalised patients and low proportion of broad spectrum antibiotics in non-critical care settings was observed potentially reflecting national antimicrobial stewardship initiatives. Broad spectrum antibiotic and antifungal prescribing in critical care units was observed indicating the importance of infection prevention and control and stewardship initiatives in this setting.

show abstract

Section: Discussionmentioning

confidence: 97%

Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals

Seaton

Gibbons

Cooper

et al. 2020

Journal of Infection

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Other studies have shown that lower PCT levels are associated with lower duration of antibiotic therapy, where the median days of therapy in patients with a PCT >0.25 ng/mL was 5 days versus 2 days in patients with a PCT level <0.25 ng/mL (p<0.001) [ 20 ]. A negative PCT group also had a lower mortality rate, ICU rate, less antibiotic usage and hospital length of stay [ 20 , 54 , 55 ]. While investigations show lower antibiotic usage in patients with a PCT value <0.5 ng/mL [ 34 ], other studies demonstrate opposing results with a lack of benefit from a stewardship/PCT strategy [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study

et al. 2022

View full text Add to dashboard Cite

Purpose Coronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods Adult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records. Results 324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia. Conclusions Baseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.

show abstract

“…Observational studies exploring PCT-guided antibiotic prescribing aimed at curbing the use of unnecessary antibiotics in patients with COVID-19 have shown that patients with low serum PCT values received fewer days of antibiotic therapy and suggest that antibiotics can be safely withheld in patients with low serum PCT levels. [37][38][39][40][41] Conversely, PCT testing in patients with COVID-19 may result in the unnecessary use of antibiotics because PCT levels may be elevated despite the absence of bacterial coinfection. 20 Our results are consistent with recent research and demonstrate that, despite the low prevalence of bacterial coinfection at presentation, patients with COVID-19 may have elevated PCT levels leading to longer courses of antibiotics, particularly "high-risk" antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of procalcitonin on antimicrobial treatment decisions in patients with coronavirus disease 2019 (COVID-19)

Conlon

Chopra

Cahalan

et al. 2022

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Objective: To describe the natural course of procalcitonin (PCT) in patients with coronavirus disease 2019 (COVID-19) and the correlation between PCT and antimicrobial prescribing to provide insight into best practices for PCT data utilization in antimicrobial stewardship in this population. Design: Single-center, retrospective, observational study. Setting: Michigan Medicine. Patients: Inpatients aged ≥18 years hospitalized March 1, 2020, through October 31, 2021, who were positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2), with ≥1 PCT measurement. Exclusion criteria included antibiotics for nonpulmonary bacterial infection on admission, treatment with azithromycin only for chronic obstructive pulmonary disease (COPD) exacerbation, and pre-existing diagnosis of cystic fibrosis with positive respiratory cultures. Methods: A structured query was used to extract data. For patients started on antibiotics, bacterial pneumonia (bPNA) was determined through chart review. Multivariable models were used to assess associations of PCT level and bPNA with antimicrobial use. Results: Of 793 patients, 224 (28.2%) were initiated on antibiotics: 33 (14.7%) had proven or probable bPNA, 125 (55.8%) had possible bPNA, and 66 (29.5%) had no bPNA. Patients had a mean of 4.1 (SD, ±5.2) PCT measurements if receiving antibiotics versus a mean of 2.0 (SD, ±2.6) if not. Initial PCT level was highest for those with proven/probable bPNA and was associated with antibiotic initiation (odds ratio 95% confidence interval [CI], 1.17–1.30). Initial PCT (rate ratio [RR] 95% CI, 1.01–1.08), change in PCT over time (RR 95% CI, 1.01–1.05), and bPNA group (RR 95% CI, 1.23–1.84) were associated with antibiotic duration. Conclusions: PCT trends are associated with the decision to initiate antibiotics and duration of treatment, independent of bPNA status and comorbidities. Prospective studies are needed to determine whether PCT level can be used to safely make decisions regarding antibiotic treatment for COVID-19.

show abstract

Routine measurement of serum procalcitonin allows antibiotics to be safely withheld in patients admitted to hospital with SARS-CoV-2 infection

Cited by 6 publications

References 32 publications

Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals

Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals

Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study

Effects of procalcitonin on antimicrobial treatment decisions in patients with coronavirus disease 2019 (COVID-19)

Contact Info

Product

Resources

About