Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world
Abstract Background Bacterial infections are not prevalent among patients hospitalized with COVID-19, while unnecessary prescription of antibiotics was commonly observed. This study aimed to determine the impact of procalcitonin testing on antibiotics prescription in the real-world setting. Methods...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-023-08849-x |
| _version_ | 1797350117544558592 |
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| author | Grace CY Lui Catherine SK Cheung Terry CF Yip Mandy SM Lai Timothy CM Li Grace LH Wong |
| author_facet | Grace CY Lui Catherine SK Cheung Terry CF Yip Mandy SM Lai Timothy CM Li Grace LH Wong |
| author_sort | Grace CY Lui |
| collection | DOAJ |
| description | Abstract Background Bacterial infections are not prevalent among patients hospitalized with COVID-19, while unnecessary prescription of antibiotics was commonly observed. This study aimed to determine the impact of procalcitonin testing on antibiotics prescription in the real-world setting. Methods We performed a territory-wide retrospective cohort study involving all laboratory-confirmed patients hospitalized in public hospitals in Hong Kong in 2020 with COVID-19. We determined the prevalence of bacterial co-infections (documented infections within 72 h of admission) and secondary bacterial infections (infections after 72 h of admission) and antibiotics consumption, and the correlation between procalcitonin testing and antibiotics prescription. Results The cohort included 8666 patients, with mean age 45.3 ± 19.9 years, 48.5% male, and comorbidities in 26.9%. Among 2688 patients with bacterial cultures performed, 147 (5.5%) had bacterial co-infections, and 222 (8.3%) had secondary bacterial infections. Antibiotics were prescribed for 2773 (32.0%) patients during the hospital admission. Procalcitonin tests were performed for 2543 (29.3%) patients. More patients with procalcitonin testing received antibiotics (65.9% vs. 17.9%, p < 0.001). Procalcitonin testing was associated with 5-fold increased risk of antibiotics prescription after adjusting for confounding variables. At hospital level, procalcitonin testing correlated with antibiotics prescription. Patients with procalcitonin level < 0.5 ng/mL had a lower probability of antibiotics initiation and shorter duration of antibiotics therapy. Conclusions Procalcitonin testing was not associated with lower prescription of antibiotics. Patients with low procalcitonin level had lower antibiotics exposure, supporting the use of procalcitonin to exclude bacterial infections aiding early stopping of antibiotics among patients hospitalized with COVID-19. |
| first_indexed | 2024-03-08T12:40:12Z |
| format | Article |
| id | doaj.art-36fc5fdade2b4faebea315d157a12c38 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-08T12:40:12Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-36fc5fdade2b4faebea315d157a12c382024-01-21T12:12:15ZengBMCBMC Infectious Diseases1471-23342024-01-012411910.1186/s12879-023-08849-xBacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real worldGrace CY Lui0Catherine SK Cheung1Terry CF Yip2Mandy SM Lai3Timothy CM Li4Grace LH Wong5Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong KongDepartment of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong KongMedical Data Analytics Centre (MDAC), The Chinese University of Hong KongMedical Data Analytics Centre (MDAC), The Chinese University of Hong KongDepartment of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong KongDepartment of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong KongAbstract Background Bacterial infections are not prevalent among patients hospitalized with COVID-19, while unnecessary prescription of antibiotics was commonly observed. This study aimed to determine the impact of procalcitonin testing on antibiotics prescription in the real-world setting. Methods We performed a territory-wide retrospective cohort study involving all laboratory-confirmed patients hospitalized in public hospitals in Hong Kong in 2020 with COVID-19. We determined the prevalence of bacterial co-infections (documented infections within 72 h of admission) and secondary bacterial infections (infections after 72 h of admission) and antibiotics consumption, and the correlation between procalcitonin testing and antibiotics prescription. Results The cohort included 8666 patients, with mean age 45.3 ± 19.9 years, 48.5% male, and comorbidities in 26.9%. Among 2688 patients with bacterial cultures performed, 147 (5.5%) had bacterial co-infections, and 222 (8.3%) had secondary bacterial infections. Antibiotics were prescribed for 2773 (32.0%) patients during the hospital admission. Procalcitonin tests were performed for 2543 (29.3%) patients. More patients with procalcitonin testing received antibiotics (65.9% vs. 17.9%, p < 0.001). Procalcitonin testing was associated with 5-fold increased risk of antibiotics prescription after adjusting for confounding variables. At hospital level, procalcitonin testing correlated with antibiotics prescription. Patients with procalcitonin level < 0.5 ng/mL had a lower probability of antibiotics initiation and shorter duration of antibiotics therapy. Conclusions Procalcitonin testing was not associated with lower prescription of antibiotics. Patients with low procalcitonin level had lower antibiotics exposure, supporting the use of procalcitonin to exclude bacterial infections aiding early stopping of antibiotics among patients hospitalized with COVID-19.https://doi.org/10.1186/s12879-023-08849-xProcalcitoninAntibiotics stewardshipCOVID-19Bacterial Infections |
| spellingShingle | Grace CY Lui Catherine SK Cheung Terry CF Yip Mandy SM Lai Timothy CM Li Grace LH Wong Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world BMC Infectious Diseases Procalcitonin Antibiotics stewardship COVID-19 Bacterial Infections |
| title | Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world |
| title_full | Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world |
| title_fullStr | Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world |
| title_full_unstemmed | Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world |
| title_short | Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world |
| title_sort | bacterial infections in patients with covid 19 the impact of procalcitonin testing on antibiotics prescription in the real world |
| topic | Procalcitonin Antibiotics stewardship COVID-19 Bacterial Infections |
| url | https://doi.org/10.1186/s12879-023-08849-x |
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