Biomarkers for antimicrobial stewardship: a reappraisal in COVID-19 times?

Berkel, Miranda van; Kox, Matthijs; Frenzel, Tim; Pickkers, Peter; Schouten, Jeroen; Waanders, Denise; Bruse, Niklas; Kooistra, Emma J.; Touw, H.R.W.; Hemelaar, Pleun; Beunders, Remi; Hoeven, Johannes van der; Velde, Sjef van der; Eng, Hetty van der; Rovers, Noortje; Klop-Riehl, Margreet; Gerretsen, Jelle; Waalders, Nicole J. B.; Claassen, Wout; Heesakkers, Hidde; Schaik, Tirsa van; Netea, Mihai G.; Joosten, Leo A. B.; Janssen, Nico; Grondman, Inge; Nooijer, Aline H. de; Mast, Quirijn de; Jaeger, Martin; Kouijzer, Ilse J.E.; Dijkstra, Helga; Lemmers, Heidi; Crevel, Reinout van; Maat, Josephine van de; Nijman, Gerine; Moorlag, Simone J.C.F.M.; Taks, Esther; Debisarun, Priya A.; Wertheim, Heiman; Hopman, Joost; Rahamat‐Langendoen, Janette; Bleeker‐Rovers, Chantal P.; Fasse, Esther; Rijssen, Esther van; Kolkman, Manon; Cranenbroek, Bram van; Smeets, Ruben; Joosten, Irma

doi:10.1186/s13054-020-03291-w

Cited by 58 publications

(74 citation statements)

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“…This finding is consistent with previous studies reporting negative PCT values for the majority of COVID-19 patients. [8][9][10] COVID-19 has presented a significant challenge to antibiotic stewardship. Our observations suggest that it is possible, after excluding patients with sepsis or identified nonpulmonary infections (eg, UTI), to reduce empiric ED prescribing rates so they more closely align with observed bacterial coinfection rates.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing patterns for coronavirus disease 2019 (COVID-19) in two emergency departments with rapid procalcitonin

Pulia

Wolf

Schwei

et al. 2020

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing patterns for coronavirus disease 2019 (COVID-19) in two emergency departments with rapid procalcitonin

Pulia

Wolf

Schwei

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…The prevalence of confirmed co-infections in patients with COVID-19 on general ward was 3.5% in a series from the US ( n = 1705) [ 10 ], 4% in a systematic review and meta-analysis from the UK (3834 patients) [ 7 ] and 8% from another review from the UK ( n = 806) [ 6 ]. Rates of co-infections in ICU patients varied from 14 to 50% [ 7 , 9 ]. Despite the overall low rates of confirmed secondary bacterial infections, the vast majority (57–86%) of COVID-19 patients received empirical antibiotic therapy [ 6 , 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…An association of PCT levels with bacterial co-infections in hospitalized patients with COVID-19 has been demonstrated in a few studies [ 3 ]. Van Berkel et al found that a PCT level of < 0.25 µg/L had a negative predictive value of 81% and a PCT > 1 µg/L had a positive predictive value of 93% for bacterial co-infection [ 9 ]. The authors concluded that antibiotic therapy can be safely withheld in patients with COVID-19 and low PCT levels on the ICU.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

et al. 2021

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Purpose Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection. Methods We performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated. Results Out of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%. Conclusion PCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.

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“…Van Berkel et al ( 6 ) measured PCT and CRP in intensive care unit (ICU) patients with COVID-19, diagnosed with secondary bacterial infection based on a positive culture and the opinion of two ICU physicians. They concluded that low PCT could be used to exclude secondary bacterial infection.…”

Section: Sirmentioning

confidence: 99%