Procalcitonin as an antibiotic stewardship tool in COVID-19 patients in the intensive care unit

Heesom, Lesley; Rehnberg, Lucas; Nasim-Mohi, Myra; Jackson, Alexander; Celinski, Michael; Dushianthan, Ahilanandan; Cook, Paul; Rivinberg, William; Saeed, Kordo

doi:10.1016/j.jgar.2020.07.017

Cited by 64 publications

(64 citation statements)

References 4 publications

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“…Furthermore, this pandemic has stressed the urgent need for identifying the differences of host response biomarkers relative to bacterial or viral infections in patients presenting with symptoms of acute respiratory illness [ 81 ]. Research indicates that procalcitonin may be a useful guide for the de-escalation of antibiotics and a useful antimicrobial stewardship tool, as the utilization of procalcitonin levels in COVID-19 patients to indicate possible bacterial infections significantly reduced antibiotic use by two days [ 82 ].…”

Section: Antibiotic Prescribing For Covid-19 and The Unnecessary Umentioning

confidence: 99%

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

Rušić

Vilović

Bukic

et al. 2021

Life

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The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.

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Section: Antibiotic Prescribing For Covid-19 and The Unnecessary Umentioning

confidence: 99%

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

Rušić

Vilović

Bukic

et al. 2021

Life

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“…The multiple regression analysis showed that older age, decreased lymphocyte count, and increased levels of procalcitonin, aspartate aminotransferase, and D-dimer were independent risk factors for disease severity. In addition, recent studies have indicated that increased procalcitonin levels in patients with COVID-19 pneumonia were associated with bacterial infections [ 10 , 11 ], suggesting that the increased severity of COVID-19 could be the result of concomitant bacterial infections, damaged cellular immunity, and impaired blood coagulation and liver functions. These results also remind us that the prevention of bacterial infections and appropriate immunotherapy may be key factors for delaying disease progression and reducing mortality.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for disease severity in COVID-19 patients: A single-center retrospective study

Xu¹,

Cai²,

Li³

et al. 2021

Journal of Intensive Medicine

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Background : The outbreak of coronavirus disease 2019 (COVID-19) has posed a huge threat to human health. However, little is known regarding the risk factors associated with COVID-19 severity. We aimed to explore early-stage disease risk factors associated with eventual disease severity. Methods : This study enrolled 486 hospitalized, non-intensive care unit (ICU)-admitted adult patients with COVID-19 (age ≥ 18 years) treated at Wuhan Jinyintan Hospital, who were divided into three groups according to disease severity. The demographic, clinical, and laboratory data at admission and clinical outcomes were compared among severity groups, and the risk factors for disease severity were identified by multiple regression analysis. Results : Of 486 patients with COVID-19, 405 (83.33%) were discharged, 33 (6.71%) died outside of the ICU, and 48 (7.20%) were still being treated in the ICU by the time the study period ended. Significant differences in age, lymphocyte counts, and the levels of procalcitonin, aspartate aminotransferase, and D-dimer ( P < 0.001 for all) among the three groups. Further analysis showed that older age, decreased lymphocyte counts, and increased procalcitonin, aspartate aminotransferase, and D-dimer levels were significantly associated with disease progression. Conclusion : Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may impair the immune system, the blood coagulation system, and hepatic and cardiac function. Some clinical characteristics and laboratory findings can help identify patients with a high risk of disease severity, which can be significant for appropriate resource allocation during the COVID-19 pandemic.

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“…Optimising antimicrobial stewardship approaches in COVID-19 is a global priority, and a recent study has indicated that procalcitonin (PCT) <0.5ng/mL offered a high negative predictive value (>95%) for the presence of bacterial co-infections (2). Elevated PCT is associated more frequently with bacterial than viral infections (3), and thus low PCT can support cessation of antibiotic prescriptions in both COVID-19 and non-COVID-19 settings (4)(5)(6)(7)(8). Unlike the inflammatory markers C-reactive protein (CRP) and white cell count (WCC), PCT is not routinely measured (9), partly due to the costs associated with its testing (10,11).…”

Section: Main Textmentioning

confidence: 99%

“…The measurement of PCT, CRP and WCC at baseline and daily during hospital admission was standard of care. We tested the hypothesis that PCT concentration was closely related to CRP or WCC levels, choosing PCT≥0.5ng/mL as threshold for the presence of bacterial pulmonary infection (4,7,8,13,14). PCT≥0.5ng/mL was associated with greater levels of CRP on admission and 48 hours into admission, independent of the need for intensive care unit (ICU) admission during the hospital stay (figs 1A+C).…”

Section: Main Textmentioning

confidence: 99%

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

Houghton

Moore

Williams

et al. 2021

Preprint

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Low procalcitonin (PCT) concentrations (<0.5ng/mL) can facilitate exclusion of bacterial co-infection in viral infections, including COVID-19. However, costs associated with PCT measurement preclude universal adoption, indicating a need to identify settings where PCT provides clinical information beyond that offered by other inflammatory markers, such as C-reactive protein (CRP) and white cell count (WCC). In an unselected cohort of 299 COVID-19 patients, we tested the hypothesis that PCT<0.5ng/mL was associated with lower levels of CRP and WCC. We demonstrated that CRP values below the geometric mean of the entire patient population had a negative predictive value for PCT<0.5ng/mL of 97.6% and 100% at baseline and 48 hours into admission respectively, and that this relationship was not confounded by intensive care admission or microbiological findings. CRP-guided PCT testing algorithms can reduce costs and support antimicrobial stewardship strategies in COVID-19.

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Procalcitonin as an antibiotic stewardship tool in COVID-19 patients in the intensive care unit

Cited by 64 publications

References 4 publications

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

Risk factors for disease severity in COVID-19 patients: A single-center retrospective study

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

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