key: cord-0856053-tv8xwan1
authors: Moseley, Philip; Jackson, Niall; Omar, Amr; Eldoadoa, Mohammed; Samaras, Christos; Birk, Rukinder; Ahmed, Farhan; Chakrabarti, Prithwiraj
title: Single centre experience of using procalcitonin to guide antibiotic therapy in COVID-19 intensive care patients
date: 2021-10-15
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2021.10.010
sha: afe702592e3407651d5ef495fbf9e549c165c855
doc_id: 856053
cord_uid: tv8xwan1

nan

Williams et al recently reported in this journal a study on using procalcitonin (PCT) to reduce antibiotic use in COVID-19 patients admitted to a tertiary teaching hospital (1) . Antibiotics have been widely used in the COVID-19 pandemic despite a low incidence of bacterial co-infection (2) . There is growing evidence that PCT can reduce antibiotic consumption among moderate to severe COVID-19 patients requiring hospital admission.

PCT has been reported as a useful marker to aid antimicrobial stewardship in hospitals and intensive care units (ICU) with an improved outcomes and lower consumption of antibiotics (3, 4) . A lower PCT has been shown to have a 94% negative predictive value for bacterial co-infection in ICU patients with confirmed influenza A (H1N1) (5) . We evaluated whether early PCT-guided antibiotic therapy results in reduced antibiotic consumption among COVID-19 population admitted to intensive care unit (ICU).

We performed a retrospective observational cohort study of COVID-19 patients who were transferred to the ICU within 72 hours of admission in Milton Keynes University Hospital, UK. All patients were transferred to ITU for either non-invasive or mechanical ventilation. A total of 48 COVID-19 patients (19 and 29 patients from waves 1 and 2, respectively) were included in the study. There were no baseline differences between the no PCT group vs PCT group except that most patients in the PCT group were from wave 2 (100% vs 15%, p <0.0001). Overall, 26/48 (54.1%) patients had at least one PCT done within the first 7 days of ICU admission and 14/26 (53.8%) patients had a first PCT value less than 0.5 ng/mL. 21/26 patients had serial PCT measurements at least 24 hours apart during their ICU stay. A total of 83 PCT levels were taken from 26 patients during their ICU stay. Of the levels taken, 47.0% (39/83) were below <0.5 ng/mL. We measured the number of days patients received antibioticsif a patient received a dose of antibiotic on a given day, then it was counted as one day of treatment. Multiple doses or different antibiotics on a single day were counted as one day of treatment.

Both median durations of antibiotic therapy in the forst 7 days after admission (7 days vs 5.5 days, Mann-Whitney test, p <0.019) and throughout admission (13.5 days vs 10 days, Mann-Whitney test, p<0.012) were significantly shorter in patients who had a PCT measured during admission (Figure 1 ). The median duration of total antibiotic days, in those patients with a first PCT value <0.5 ng/mL, was 7.5 days compared to 12.5 days J o u r n a l P r e -p r o o f for patients who had the first PCT value >0.5 ng/mL (p<0.05). 8 patients who had a PCT value <0.25 ng/mL within the first 7 days had the lowest antibiotic exposure (median 4 days) in the first 7 days as well as during the total hospital stay (median 5.5 days).

The mortality across the population was 35.4%. There was no significant difference in mortality between the two groups. The incidence of at least one ICU-acquired infection was 37.5% and most of these infections 

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