Procalcitonin accurately predicts mortality but not bacterial infection in COVID-19 patients admitted to intensive care unit

Vanhomwegen, Charlotte; Veliziotis, Ioannis; Malinverni, Stefano; Konopnicki, Déborah; Dechamps, Philippe; Claus, Marc; Roman, Alain; Cotton, Frédéric; Dauby, Nicolás

doi:10.1007/s11845-020-02485-z

Cited by 44 publications

(49 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A PCT cut-off of <0.5 pg/mL was used in this study, as opposed to a lower cut-off of <0.25 pg/L in our practice. The Vanhomwegen et al study also looked at PCT usage (cut-off of <0.5 pg/mL) in the critical care unit, but only investigated the association of PCT with confirmed bacterial infection [ 10 ]. The low yield of positive isolates in this small study was underpowered to demonstrate any association with PCT and bacterial co-infection; antibacterial usage was not studied.…”

Section: Discussionmentioning

confidence: 99%

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

2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

2021

View full text Add to dashboard Cite

show abstract

“…Certain guidelines also recommend a short course of antibiotics in case of radiological findings and inflammatory markers compatible with a bRTI, despite their low positive predictive value and the weak level of evidence [40,41]. However, physicians can use a negative microbiological result of respiratory tract samples or blood cultures in their decision to interrupt antibiotic treatment, as well as the presence of low procalcitonin levels, which has a high negative predictive value for a bacterial pneumonia [16,19,42].…”

Section: Discussionmentioning

confidence: 99%

“…However, the diagnosis of such infections can be challenging, especially in patients with COVID-19. Although biomarkers for bacterial diseases and medical imaging can be useful diagnostic and prognostic tools, they lack specificity for diagnoses of bRTIs in patients with COVID-19 [16][17][18][19]. These are all reasons why the continuation of antimicrobial stewardship team (AST) programmes during the COVID-19 pandemic is highly recommended.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Prescriptions Targeting Bacterial Respiratory Infections in Admitted Patients with COVID-19: A Prospective Observational Study

et al. 2021

View full text Add to dashboard Cite

Introduction: Although bacterial co-and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods:In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of Johan Van Laethem and Stephanie Wuyts contributed equally.

show abstract

“…Di culties identifying the small numbers of patients who may bene t from antibacterial results early in their presentation in among the wider excess antibacterial usage remains a challenge. Procalcitonin has con icting supporting evidence for its role in COVID-19 [8,11]. Concerns about raised PCT results in response to ARDs have been suggested to limit its utility.…”

Section: Resultsmentioning

confidence: 99%

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

Hughes

Mughal

Moore

2021

Preprint

View full text Add to dashboard Cite

Background: 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. Method: A retrospective observational analysis was undertaken 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 (<0.25mg/L) and antibacterial course length. 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 hours. 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 (7.9days vs 10.1days;p=0.044), and intensive care unit (ICU) admission (13.9% vs 40.8%;p=0.001) were seen among patients with low PCT. Conclusion: 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 hour review.

show abstract

Procalcitonin accurately predicts mortality but not bacterial infection in COVID-19 patients admitted to intensive care unit

Cited by 44 publications

References 10 publications

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

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

Antibiotic Prescriptions Targeting Bacterial Respiratory Infections in Admitted Patients with COVID-19: A Prospective Observational Study

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

Contact Info

Product

Resources

About