ABSTRACT
It can be a diagnostic challenge to identify patients with coronavirus disease 2019 in whom antibiotics can be safely withheld. This study evaluated the effectiveness of a guideline implemented at Sheffield Teaching Hospitals NHS Foundation Trust that recommends withholding antibiotics in patients with low serum procalcitonin (PCT), defined as ≤0.25 ng/mL. Results showed reduced antibiotic consumption in patients with PCT ≤0.25 ng/mL with no increase in mortality, alongside a reduction in subsequent carbapenem prescriptions during admission. The results support the effectiveness of this guideline, and further research is recommended to identify the optimal cut-off value for PCT in this setting.
Subject(s)
Anti-Bacterial Agents/standards , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/standards , Antiviral Agents/therapeutic use , Bacterial Infections/drug therapy , COVID-19 Drug Treatment , Procalcitonin/blood , Adolescent , Adult , Aged , Aged, 80 and over , Antimicrobial Stewardship/methods , Bacterial Infections/blood , Biomarkers/blood , Cohort Studies , Coinfection/blood , Coinfection/drug therapy , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , Retrospective Studies , Young AdultABSTRACT
Data were collected from 1057 consecutive patients who received patient-controlled epidural analgesia for postoperative pain relief, using 0.1% bupivacaine with 5 microg x ml(-1) fentanyl in all cases. Prescriptions were not otherwise standardised. On the first postoperative day, 741/801 patients (92.5%) had adequate analgesia and 692/719 (96.2%) were free of nausea. During a total of 3858 treatment days, two patients (0.19%) had an episode of severe respiratory depression and one patient (0.09%) became unrousable. Hypotension occurred in 45 patients (4.3%). There were no cases of epidural haematoma or abscess. We conclude that a patient-controlled epidural analgesia service as described is both efficacious and safe for use on surgical wards.
