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Diagnostic yield of bacteriological tests and predictors of severe outcome in adult patients with COVID-19 presenting to the emergency department.
Kaal, Anna; Snel, Lars; Dane, Martijn; van Burgel, Nathalie; Ottens, Thomas; Broekman, Winifred; El Bouazzaoui, Lahssan; Kolfschoten, Nikki; Schippers, Emile; Steyerberg, Ewout; Meziyerh, Soufian; van Nieuwkoop, Cees.
  • Kaal A; Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands a.g.kaal@hagaziekenhuis.nl.
  • Snel L; Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands.
  • Dane M; Clinical Chemistry, Haga Teaching Hospital, Den Haag, The Netherlands.
  • van Burgel N; Medical Microbiology, Haga Teaching Hospital, Den Haag, The Netherlands.
  • Ottens T; Intensive Care, Haga Teaching Hospital, Den Haag, The Netherlands.
  • Broekman W; Pulmonology, Haga Teaching Hospital, Den Haag, The Netherlands.
  • El Bouazzaoui L; Pulmonology, Haga Teaching Hospital, Den Haag, The Netherlands.
  • Kolfschoten N; Emergency Medicine, Haga Teaching Hospital, Den Haag, The Netherlands.
  • Schippers E; Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands.
  • Steyerberg E; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
  • Meziyerh S; Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
  • van Nieuwkoop C; Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands.
Emerg Med J ; 38(9): 685-691, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1320447
ABSTRACT

BACKGROUND:

Guidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate the yield of bacteriological tests, including blood and sputum cultures, and the association of multiple biomarkers and the Pneumonia Severity Index (PSI) with clinical and microbiological outcomes in patients with COVID-19 presenting to the emergency department (ED).

METHODS:

This is a substudy of a large observational cohort study (PredictED study). The PredictED included adult patients from whom a blood culture was drawn at the ED of Haga Teaching Hospital, The Netherlands. For this substudy, all patients who tested positive for SARS-CoV-2 by PCR in March and April 2020 were included. The primary outcome was the incidence of bacterial coinfection. We used logistic regression analysis for associations of procalcitonin, C reactive protein (CRP), ferritin, lymphocyte count and PSI score with a severe disease course, defined as intensive care unit admission and/or 30-day mortality. The area under the receiver operating characteristics curve (AUC) quantified the discriminatory performance.

RESULTS:

We included 142 SARS-CoV-2 positive patients. On presentation, the median duration of symptoms was 8 days. 41 (29%) patients had a severe disease course and 24 (17%) died within 30 days. The incidence of bacterial coinfection was 2/142 (1.4%). None of the blood cultures showed pathogen growth while 6.3% was contaminated. The AUCs for predicting severe disease were 0.76 (95% CI 0.68 to 0.84), 0.70 (0.61 to 0.79), 0.62 (0.51 to 0.74), 0.62 (0.51 to 0.72) and 0.72 (0.63 to 0.81) for procalcitonin, CRP, ferritin, lymphocyte count and PSI score, respectively.

CONCLUSION:

Blood cultures appear to have limited value while procalcitonin and the PSI appear to be promising tools in helping physicians identify patients at risk for severe disease course in COVID-19 at presentation to the ED.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Bacterial Infections / Bacteriological Techniques / Coinfection / COVID-19 Subject: Bacterial Infections / Bacteriological Techniques / Coinfection / COVID-19 Type of study: Diagnostic study / Incidence study / Observational study / Prognostic study / Risk factors Language: English Journal: Emerg Med J Clinical aspect: Diagnosis / Etiology / Prediction / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Bacterial Infections / Bacteriological Techniques / Coinfection / COVID-19 Subject: Bacterial Infections / Bacteriological Techniques / Coinfection / COVID-19 Type of study: Diagnostic study / Incidence study / Observational study / Prognostic study / Risk factors Language: English Journal: Emerg Med J Clinical aspect: Diagnosis / Etiology / Prediction / Prognosis Year: 2021
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