Procalcitonin algorithm reduced antibiotic use in COVID-19 inpatients
A Dutch intervention used procalcitonin levels in inpatients with COVID-19 to guide antibiotic use, with an algorithm discouraging prescriptions if levels were less than 0.25 ng/mL and recommending antibiotics for patients with levels above 0.5 ng/mL.
Inpatients with COVID-19 were less likely to receive antibiotics if their care was guided by procalcitonin (PCT) testing, a study found.
The Dutch study compared antibiotic consumption among three groups of COVID-19 patients: one treated based on a PCT algorithm (n=216), a control group from the same hospital (n=57), and a control group of patients from three similar hospitals (n=486) during the same period. In the intervention group, PCT was measured within 24 hours of admission. For these patients, antibiotics were discouraged at PCT levels less than 0.25 ng/mL, considered for patients with PCT levels of 0.25 to 0.5 ng/mL, and recommended at PCT levels above 0.5 ng/mL. The primary endpoint was antibiotic prescriptions in the first week of admission. Results were published by CHEST on April 26.
Significantly fewer patients in the PCT-guided group received antibiotic prescriptions during the first seven days: 26.8% compared to 43.9% in the same-hospital control group and 44.7% in the other-hospital group (odds ratios [ORs], 0.33 [95% CI, 0.16 to 0.66] and 0.42 [95% CI, 0.28 to 0.62], respectively). The rates of antibiotic use during the patients' entire admission were 35.2%, 43.9%, and 54.5%, respectively, resulting in a significant difference only between the PCT group and the other-hospital group (OR, 0.23; 95% CI, 0.08 to 0.63). There were no significant differences among the groups on 30- and 90-day mortality, ICU admission, or length of stay. Readmissions were higher in the PCT group than the other-hospital group, mainly due to noninfectious causes.
“Our findings are in line with previous studies investigating the use of PCT in guiding antibiotic therapy in patients with COVID-19,” the study authors wrote. “The strength of our study is that we are the first to implement a prospective PCT-guided protocol in the treatment of patients with COVID-19.” They noted that adherence to the PCT protocol was high, demonstrating that the approach was feasible for hospitals treating patients with COVID-19. They called for a randomized controlled trial comparing PCT guidance to usual care in such patients.
Limitations include the partly retrospective design of the study and the evolving nature of COVID-19 infection and treatment over the analyzed period, the authors noted.
