Single-centre experience of using procalcitonin to guide antibiotic therapy in COVID-19 intensive care patients

Moseley, Philip; Jackson, Niall; Omar, Amr S; Eldoadoa, Mohammed; Samaras, Christos; Birk, Rukinder; Ahmed, Farhan; Chakrabarti, Prithwiraj

doi:10.1016/j.jhin.2021.10.010

Cited by 6 publications

(1 citation statement)

References 5 publications

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“…Real world data of PCT-guidance in COVID-19 support its use for a judicious antimicrobial approach. In a small retrospective cohort of 48 patients, median duration of antimicrobials was shorter if at least one PCT measurement was performed [99]. Similar results were also reported by Calderon et al [100].…”

Section: Antimicrobial Stewardship Using Biomarkers In the Covid-19 Erasupporting

confidence: 85%

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Kyriazopoulou

Giamarellos‐Bourboulis

2022

Antibiotics

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This review aims to summarize current progress in the management of critically ill, using biomarkers as guidance for antimicrobial treatment with a focus on antimicrobial stewardship. Accumulated evidence from randomized clinical trials (RCTs) and observational studies in adults for the biomarker-guided antimicrobial treatment of critically ill (mainly sepsis and COVID-19 patients) has been extensively searched and is provided. Procalcitonin (PCT) is the best studied biomarker; in the majority of randomized clinical trials an algorithm of discontinuation of antibiotics with decreasing PCT over serial measurements has been proven safe and effective to reduce length of antimicrobial treatment, antibiotic-associated adverse events and long-term infectious complications like infections by multidrug-resistant organisms and Clostridioides difficile. Other biomarkers, such as C-reactive protein and presepsin, are already being tested as guidance for shorter antimicrobial treatment, but more research is needed. Current evidence suggests that biomarkers, mainly procalcitonin, should be implemented in antimicrobial stewardship programs even in the COVID-19 era, when, although bacterial coinfection rate is low, antimicrobial overconsumption remains high.

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Section: Antimicrobial Stewardship Using Biomarkers In the Covid-19 Erasupporting

confidence: 85%

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Kyriazopoulou

Giamarellos‐Bourboulis

2022

Antibiotics

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A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19

Sandoe,

Grozeva,

Albur

et al. 2024

Journal of Antimicrobial Chemotherapy

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Background Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK. Objectives Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups. Methods Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020. Results Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22–0.64 days, P < 0.001) and of 0.72 days (95% CI: 0.06–1.38 days, P = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections. Conclusions Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility. Study registration number ISRCTN66682918.

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C-reactive protein-guided use of procalcitonin in COVID-19

Houghton

Moore

Williams

et al. 2021

JAC-Antimicrobial Resistance

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Background A low procalcitonin (PCT) concentration facilitates exclusion of bacterial co-infections in COVID-19, but high costs associated with PCT measurements preclude universal adoption. Changes in inflammatory markers, including C-reactive protein (CRP), can be concordant, and predicting low PCT concentrations may avoid costs of redundant tests and support more cost-effective deployment of this diagnostic biomarker. Objectives To explore whether, in COVID-19, low PCT values could be predicted by the presence of low CRP concentrations. Methods Unselected cohort of 224 COVID-19 patients admitted to hospital that underwent daily PCT and CRP measurements as standard care. Both 0.25 ng/mL and 0.5 ng/mL were used as cut-offs for positive PCT test results. Geometric mean was used to define high and low CRP values at each timepoint assessed. Results Admission PCT was <0.25 ng/mL in 160/224 (71.4%), 0.25–0.5 ng/mL in 27 (12.0%) and >0.5 ng/mL in 37 (16.5%). Elevated PCT was associated with increased risk of death (P = 0.0004) and was more commonly associated with microbiological evidence of bacterial co-infection (P < 0.0001). For high CRP values, significant heterogeneity in PCT measurements was observed, with maximal positive predictive value of 50% even for a PCT cut-off of 0.25 ng/mL. In contrast, low CRP was strongly predictive of low PCT concentrations, particularly <0.5 ng/mL, with a negative predictive value of 97.6% at time of hospital admission and 100% 48 hours into hospital stay. Conclusions CRP-guided PCT testing algorithms can reduce unnecessary PCT measurement and costs, supporting antimicrobial stewardship strategies in COVID-19.

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Single-centre experience of using procalcitonin to guide antibiotic therapy in COVID-19 intensive care patients

Cited by 6 publications

References 5 publications

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19

C-reactive protein-guided use of procalcitonin in COVID-19

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