A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19
Author:
Sandoe Jonathan A T12ORCID, Grozeva Detelina3ORCID, Albur Mahableshwar4, Bond Stuart E5ORCID, Brookes-Howell Lucy3, Dark Paul6ORCID, Euden Joanne3ORCID, Hamilton Ryan78, Hellyer Thomas P910, Henley Josie11, Hopkins Susan12, Howard Philip13ORCID, Howdon Daniel14, Knox-Macaulay Chikezie15, Llewelyn Martin J16, Maboshe Wakunyambo3, McCullagh Iain J910, Ogden Margaret15, Parsons Helena K17, Partridge David G17ORCID, Powell Neil18ORCID, Prestwich Graham15, Shaw Dominick19, Shinkins Bethany1420, Szakmany Tamas2122, Thomas-Jones Emma3, Todd Stacy23, West Robert M14, Carrol Enitan D24, Pallmann Philip3, , Sandoe Jonathan, Carrol Enitan, Thomas-Jones Emma, Euden Joanne, Brookes-Howell Lucy, Henley Josie, Maboshe Wakunyambo, Pallmann Philip, Grozeva Detelina, Bargiel Marcin, Evans Judith, Webb Edward, Bestwick Rebecca, Howdon Daniel, King Natalie, Shinkins Bethany, West Robert, Richman Colin, Gerver Sarah, Hope Russell, Hopkins Susan, Heginbothom Margaret, Howard Philip, Sandoe Jonathan, Berry Claire, Davis Georgina, Wilkinson Vikki, Todd Stacy, Taylor-Barr Eleanor, Brodsky Mary, Brown Jo, Burns Jenni, Glynn Sharon, Gureviciute Alvyda, Howard Megan, Kirkpatrick Jennifer, Muphy Hannah, Richardson Emma, Scanlon Deborah, Small Claire, Sweeney Graham, Williams Lisa, Szakmany Tamas, Baker Evelyn, Cheema Yusuf, Dunhill Jill, Killick Charlotte, King Charlie, Kooner Simran, Lewis Swyn, Nash Maxine, Richardson Owen, Tuffney Jemma, Westacott Clare, Williams Sarah, Partridge David, Parsons Helena, Cawthron Kay, Tai Yuen Kiu, Newman Thomas, Plowright Megan, Shulver Helen, Sivakova Anna, Powell Neil, Ayliffe Freddie, Darke Emma, Fletcher Eve, Hammonds Fiona, Marquez Gladys, Welch Leanne, Bond Stuart, Lee-Milner Jade, Spencer Joseph, Albur Mahableshwar, Brandao Rodrigo, Hrycaiczuk Joshua, Stanley Jack, Llewelyn Martin, Cross Elizabeth, Hansen Daniel, Redmore Ethan, Whyte Abigail, Hellyer Tom, McCullagh Iain, Brown Benjamin, Calabrese Michele, Cole Cameron, DeSousa Jessica, Dunn Leigh, Grieveson Stephanie, Gulati Arti, Issac Elizabeth, Mackay Ruaridh, Simoes Fatima, Dark Paul, Apatri Elena, Charles Bethan, Christensen Helen, Harvey Alice, Lomas Diane, Taylor Melanie, Thomas Vicky, Walker Danielle, Shaw Dominick, Howard Lucy, Joseph Amelia, Sultan Saheer, Knox-Macaulay Chikezie, Ogden Margaret, Prestwich Graham, Hamilton Ryan
Affiliation:
1. Department of Microbiology, The General Infirmary at Leeds , Leeds , UK 2. Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds , Leeds , UK 3. Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University , Cardiff , UK 4. Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust , Bristol , UK 5. Pharmacy Department, Mid Yorkshire Teaching NHS Trust , Wakefield , UK 6. Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester , UK 7. Antibiotic Research UK , York , UK 8. School of Pharmacy, De Montfort University , Leicester , UK 9. Royal Victoria Infirmary, Newcastle and Freeman Hospital, Newcastle-upon-Tyne Hospital NHS Foundation Trust , Newcastle-upon-Tyne , UK 10. Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University , Newcastle , UK 11. School of Social Sciences, Cardiff University , Cardiff , UK 12. UK Health Security Agency , London , UK 13. NHS England and NHS Improvement , North-East and Yorkshire Region , UK 14. Leeds Institute for Health Sciences, University of Leeds , Leeds , UK 15. Public and Patient Involvement Representative, Centre for Trials Research, Cardiff University , Cardiff , UK 16. Brighton and Sussex Medical School, University of Sussex and University Hospitals Sussex NHS Foundation Trust , Brighton , UK 17. Department of Microbiology, Laboratory Medicine, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK 18. Pharmacy Department, Royal Cornwall Hospitals NHS Foundation Trust , Truro , UK 19. Leicester NIHR Biomedical Research Centre and Department of Respiratory Sciences, University of Leicester , Leicester , UK 20. Division of Health Sciences, Warwick Medical School, University of Warwick , Coventry , UK 21. Critical Care Directorate, Aneurin Bevan University Health Board , Cwmbran , UK 22. Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University , Cardiff , UK 23. Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust , Liverpool , UK 24. Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool , Liverpool , UK
Abstract
Abstract
Background
Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK.
Objectives
Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups.
Methods
Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020.
Results
Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22–0.64 days, P < 0.001) and of 0.72 days (95% CI: 0.06–1.38 days, P = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections.
Conclusions
Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility.
Study registration number
ISRCTN66682918.
Funder
National Institute of Health and Care Research COVID Recovery & Learning Health and Care Research Wales Manchester NIHR Biomedical Research Centre NIHR Senior Investigator Award
Publisher
Oxford University Press (OUP)
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