Skip to main content Accessibility help
×
Home
Hostname: page-component-55b6f6c457-s8qdg Total loading time: 0.165 Render date: 2021-09-24T23:36:12.686Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

The Role of Procalcitonin in Antibiotic Decision-Making in Covid-19 Infection

Published online by Cambridge University Press:  19 April 2021

Valeria Fabre*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine Department of Antimicrobial Stewardship, The Johns Hopkins Hospital
Sara Karaba
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine
Joe Amoah
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
Matthew Robinson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine
George Jones
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine
Kathryn Dzintars
Affiliation:
Department of Antimicrobial Stewardship, The Johns Hopkins Hospital
Morgan Katz
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine
B. Mark Landrum
Affiliation:
4 Howard County General Hospital, Columbia, MD
Sarojini Qasba
Affiliation:
Suburban Hospital, Bethesda, MD
Pooja Gupta
Affiliation:
Sibley Memorial Hospital, Washington, DC
Eili Klein
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Center for Disease Dynamics, Economics & Policy, Washington, DC
Sara E. Cosgrove
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine Department of Antimicrobial Stewardship, The Johns Hopkins Hospital
*
Corresponding author: Valeria Fabre, MD, 600 North Wolfe Street, Osler 425, Baltimore, Maryland 21287, Tel (443)-287-4392, Fax (410) 614-5425, mfabre1@jhmi.edu

Abstract

Objective:

To evaluate the role of procalcitonin (PCT) 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 hospitals 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 to clinical criteria in detecting bCAP were evaluated with receiving operating curve characteristics (ROC).

Results:

64% (611/962) of patients received a PCT. ROC curves for clinical criteria and clinical criteria plus PCT were similar (at 0.5ng/ml and 0.25ng/ml). By bCAP group, median initial PCT values were 0.58 ng/mL (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. Among patients without bCAP, an elevatedPCT was associated with 1.8 additional days of CAP therapy (95% CI 1.01 2.75, P<0.01) compared to patients with a negative PCT after adjusting for potential confounders. Duration of CAP therapy was similar between patients without a PCT ordered and a low PCT for no bCAP and possible bCAP groups.

Conclusions:

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

Type
Original Article
Copyright
2021 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The Role of Procalcitonin in Antibiotic Decision-Making in Covid-19 Infection
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

The Role of Procalcitonin in Antibiotic Decision-Making in Covid-19 Infection
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

The Role of Procalcitonin in Antibiotic Decision-Making in Covid-19 Infection
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *