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Evaluation of procalcitonin-guided antimicrobial stewardship in patients admitted to hospital with COVID-19 pneumonia.
Calderon, Maria; Li, Ang; Bazo-Alvarez, Juan Carlos; Dennis, Jonathan; Baker, Kenneth F; Schim van der Loeff, Ina; Hanrath, Aidan T; Capstick, Richard; Payne, Brendan A I; Weiand, Daniel; Hunter, Ewan; Schwab, Ulrich.
  • Calderon M; Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
  • Li A; Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
  • Bazo-Alvarez JC; Research Department of Primary Care & Population Health, University College London, London, UK.
  • Dennis J; Escuela de Medicina, Universidad Cesar Vallejo, Trujillo, Peru.
  • Baker KF; Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
  • Schim van der Loeff I; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
  • Hanrath AT; NIHR Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
  • Capstick R; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
  • Payne BAI; Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
  • Weiand D; Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
  • Hunter E; Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
  • Schwab U; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
JAC Antimicrob Resist ; 3(3): dlab133, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1371735
ABSTRACT

BACKGROUND:

Procalcitonin is a biomarker that may be able to identify patients with COVID-19 pneumonia who do not require antimicrobials for bacterial respiratory tract co-infections.

OBJECTIVES:

To evaluate the safety and effectiveness of a procalcitonin-guided algorithm in rationalizing empirical antimicrobial prescriptions in non-critically ill patients with COVID-19 pneumonia.

METHODS:

Retrospective, single-site, cohort study in adults hospitalized with confirmed or suspected COVID-19 pneumonia and receiving empirical antimicrobials for potential bacterial respiratory tract co-infection. Regression models were used to compare the following outcomes in patients with and without procalcitonin testing within 72 h of starting antimicrobials antimicrobial consumption (DDD); antimicrobial duration; a composite safety outcome of death, admission to HDU/ICU or readmission to hospital within 30 days; and length of admission. Procalcitonin levels of ≤0.25 ng/L were interpreted as negatively predictive of bacterial co-infection. Effects were expressed as ratios of means (ROM) or prevalence ratios (PR) accordingly.

RESULTS:

259 patients were included in the final analysis. Antimicrobial use was lower in patients who had procalcitonin measured within 72 h of starting antimicrobials mean antimicrobial duration 4.4 versus 5.4 days, adjusted ROM 0.7 (95% CI 0.6-0.9); mean antimicrobial consumption 6.8 versus 8.4 DDD, adjusted ROM 0.7 (95% CI 0.6-0.8). Both groups had similar composite safety outcomes (adjusted PR 0.9; 95% CI 0.6-1.3) and lengths of admission (adjusted ROM 1.3; 95% CI 0.9-1.6).

CONCLUSIONS:

A procalcitonin-guided algorithm may allow for the safe reduction of antimicrobial usage in hospitalized non-critically ill patients with COVID-19 pneumonia.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: JAC Antimicrob Resist Year: 2021 Document Type: Article Affiliation country: Jacamr

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: JAC Antimicrob Resist Year: 2021 Document Type: Article Affiliation country: Jacamr