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The role of procalcitonin results in antibiotic decision-making in coronavirus disease 2019 (COVID-19)

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  19 April 2021

Valeria Fabre Open the ORCID record for Valeria Fabre [Opens in a new window] ,
Sara Karaba ,
Joe Amoah ,
Matthew Robinson ,
George Jones ,
Kathryn Dzintars ,
Morgan Katz ,
B. Mark Landrum ,
Sarojini Qasba  and
Pooja Gupta
...Show all authors
Valeria Fabre*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore, Maryland
Sara Karaba
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Joe Amoah
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Matthew Robinson
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
George Jones
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Kathryn Dzintars
Affiliation:
Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore, Maryland
Morgan Katz
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
B. Mark Landrum
Affiliation:
Howard County General Hospital, Columbia, Maryland
Sarojini Qasba
Affiliation:
Suburban Hospital, Bethesda, Maryland
Pooja Gupta
Affiliation:
Sibley Memorial Hospital, Washington, DC
Eili Klein
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Center for Disease Dynamics, Economics & Policy, Washington, DC
Sara E. Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Antimicrobial Stewardship, The Johns Hopkins Hospital, Baltimore, Maryland
*
Author for correspondence: Valeria Fabre, MD, E-mail: mfabre1@jhmi.edu
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Abstract

Objective:

To evaluate the role of procalcitonin (PCT) results in antibiotic decisions for COVID-19 patients at hospital presentation.

Design, setting, and participants:

Multicenter retrospective observational study of patients ≥18 years hospitalized due to COVID-19 at the Johns Hopkins Health system. Patients who were transferred from another facility with >24 hours stay and patients who died within 48 hours of hospitalization were excluded.

Methods:

Elevated PCT values were determined based on each hospital’s definition. Antibiotic therapy and PCT results were evaluated for patients with no evidence of bacterial community-acquired pneumonia (bCAP) and patients with confirmed, probable, or possible bCAP. The added value of PCT testing to clinical criteria in detecting bCAP was evaluated using receiving operating curve characteristics (ROC).

Results:

Of 962 patients, 611 (64%) received a PCT test. ROC curves for clinical criteria and clinical criteria plus PCT test were similar (at 0.5 ng/mL and 0.25 ng/mL). By bCAP group, median initial PCT values were 0.58 ng/mL (interquartile range [IQR], 0.24–1.14), 0.23 ng/mL (IQR, 0.1–0.63), and 0.15 ng/mL (IQR, 0.09–0.35) for proven/probable, possible, and no bCAP groups, respectively. Among patients without bCAP, an elevated PCT level was associated with 1.8 additional days of CAP therapy (95% CI, 1.01–2.75; P < .01) compared to patients with a negative PCT result after adjusting for potential confounders. Duration of CAP therapy was similar between patients without a PCT test ordered and a low PCT level for no bCAP and possible bCAP groups.

Conclusions:

PCT results may be abnormal in COVID-19 patients without bCAP and may result in receipt of unnecessary antibiotics.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 5 , May 2022 , pp. 570 - 575
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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