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Background Despite the low rate of bacterial co-infection, antibiotics are very commonly prescribed in hospitalised COVID-19 patients. Research question Does the use of a PCT-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection? Study design and methods In this multicentre cohort, 3 groups of COVID-19 patients were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n=216) and 2 control groups, consisted of patients from the same hospital (n=57) and of patients from 3 similar hospitals (n=486) without PCT measurements during the same period. The primary endpoint was antibiotic prescription in the first week of admission. Results Antibiotic prescription during the first 7 days was 26.8% in the PCT-group, 43.9% in the non-PCT group in the same hospital and 44.7% in the non-PCT group in other hospitals. Patients in the PCT-group had lower odds of receiving antibiotics in the first 7 days of admission (OR 0.33;0.16 - 0.66 compared to the same hospital and OR 0.42;95% CI 0.28 – 0.62 compared to the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was respectively 35.2%, 43.9% and 54.5%. The PCT-group had lower odds of receiving antibiotics during the total admission only when compared to the other hospitals (OR 0.23;95%CI 0.08 - 0.63). There were no significant differences in other secondary endpoints, except for re-admission in the PCT-group versus the other hospitals group. Interpretation : PCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalised patients with COVID-19, without major safety concerns.
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INTRODUCTION: High flow nasal cannula (HFNC) reduces the need for intubation in patients with hypoxaemic acute respiratory failure (ARF), but its added value in patients with severe coronavirus disease 2019 (COVID-19) and a do-not-intubate (DNI) order is unknown. We aimed to assess (variables associated with) survival in these patients. MATERIALS AND METHODS: We described a multicentre retrospective observational cohort study in five hospitals in the Netherlands and assessed the survival in COVID-19 patients with severe acute respiratory failure and a DNI order who were treated with high flow nasal cannula. We also studied variables associated with survival. RESULTS AND DISCUSSION: One-third of patients survived after 30 days. Survival was 43.9% in the subgroup of patients with a good WHO performance status and only 16.1% in patients with a poor WHO performance status. Patients who were admitted to the hospital for a longer period prior to HFNC initiation were less likely to survive. HFNC resulted in an increase in ROX values, reflective of improved oxygenation and/or decreased respiratory rate. CONCLUSION: Our data suggest that a trial of HFNC could be considered to increase chances of survival in patients with ARF due to COVID-19 pneumonitis and a DNI order, especially in those with a good WHO performance status.