TY - JOUR
T1 - Procalcitonin-Guided Antibiotic Prescription in Patients With COVID-19
T2 - A Multicenter Observational Cohort Study
AU - Hessels, Lisa M.
AU - Speksnijder, Esther
AU - Paternotte, Nienke
AU - van Huisstede, Astrid
AU - Thijs, Willemien
AU - Scheer, Margot
AU - van der Steen-Dieperink, Mariëlle
AU - Knarren, Lieve
AU - van den Bergh, Joop P.
AU - Winckers, Kristien
AU - Henry, Ronald
AU - CovidPredict Study Group
AU - Simsek, Suat
AU - Boersma, Wim G.
AU - Appelman, Brent
AU - Schinkel, Michiel
AU - Buis, David
AU - Sigalof, Kim C. E.
AU - Elbers, Paul W. G.
AU - Rusch, Daisy
AU - Reidinga, Auke
AU - Moeniralam, Hazra
AU - Wyers, Caroline
AU - van den Bergh, Joop
AU - van Dam, Bastiaan
AU - van den Gritters, Niels C.
AU - Bokhizzou, Nejma
AU - Brinkman, Kees
AU - de Kruif, Martijn
AU - Dormans, Tom
AU - Douma, Renée
AU - de Haan, Lianne R.
AU - Fung, Tsz Yeung
AU - Beudel, Martijn
N1 - Funding Information: Author contributions: L. M. H. takes full responsibility for the content of the manuscript including the data and analyses. L. M. H. contributed to study conception, study design, study management, data analysis, data interpretation, and manuscript writing. E. S. contributed to study management, data interpretation, and critical review of the manuscript. N. P. contributed to study management and critical review of the manuscript. A. v. H. and W. T. contributed to data interpretation and critical review of the manuscript. M. S. M. v. d. S.-D. L. K. J. P. v. D. B. K. W. and R. H. contributed to data collection and critical review of the manuscript. S. S. contributed to study conception, study design, data interpretation, and critical review of the manuscript. W. G. B. contributed as supervisor and to study conception, study design, data interpretation, and critical review of the manuscript. ∗COVIDPredict Study Group Collaborators: Brent Appelman, MD (Center for Experimental and Molecular Medicine, Amsterdam UMC, Amsterdam, The Netherlands; The Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands); Michiel Schinkel, MD (Center for Experimental and Molecular Medicine, Amsterdam UMC, Amsterdam, The Netherlands; The Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands); David Buis, MD (Division of Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands); Kim C. E. Sigalof, MD, PhD (Division of Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands); Paul W. G. Elbers, MD, PhD (Department of Intensive Care, Amsterdam UMC, Amsterdam, The Netherlands); Daisy Rusch, MD (Department of General Practice, Martini Hospital, Groningen, The Netherlands); Auke Reidinga, MD (Intensive Care Unit, Martini Hospital, Groningen, The Netherlands); Hazra Moeniralam, MD, PhD (Department of Internal Medicine and Intensive Care Unit, St Antonius Hospital, Nieuwegein, The Netherlands); Caroline Wyers, PhD (Department of Internal Medicine and Intensive Care Unit, St Antonius Hospital, Nieuwegein, The Netherlands); Joop van den Bergh, MD, PhD (Department of Internal Medicine, Viecuri MC Noord-Limburg, Venlo, The Netherlands); Suat Simsek, MD, PhD (Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands); Bastiaan van Dam, MD, PhD (Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands); Niels C. Gritters, MD (Intensive Care Unit, Treant Zorggroep, Emmen, The Netherlands); Nejma Bokhizzou, MD (Department of Internal Medicine, BovenIJ Hospital, Amsterdam, The Netherlands); Kees Brinkman, MD, PhD (Department of Internal Medicine, OLVG, Amsterdam, The Netherlands); Martijn de Kruif, MD, PhD (Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands); Tom Dormans, MD, PhD (Department of Internal Medicine, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands); Renée Douma, MD, PhD (Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands); Lianne R. de Haan, MD (Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands); Tsz Yeung Fung, MD (Department of Internal Medicine, Section of Nephrology, Maastricht UMC, Maastricht, The Netherlands); and Martijn Beudel, MD, PhD (Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam UMC, Amsterdam, The Netherlands). Other contributions: We thank the COVIDPredict consortium (www.covidpredict.org) for their efforts in providing patient data. Additional information: The e-Figures and e-Tables are available online under “Supplementary Data.” Publisher Copyright: © 2023 American College of Chest Physicians
PY - 2023/9
Y1 - 2023/9
N2 - Background: Despite the low rate of bacterial coinfection, antibiotics are very commonly prescribed in hospitalized patients with COVID-19. Research Question: Does the use of a procalcitonin (PCT)-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection? Study Design and Methods: In this multicenter cohort, three groups of patients with COVID-19 were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n = 216) and two control groups, consisting of patients from the same hospital (n = 57) and of patients from three similar hospitals (n = 486) without PCT measurements during the same period. The primary end point was antibiotic prescription in the first week of admission. Results: Antibiotic prescription during the first 7 days was 26.8% in the PCT group, 43.9% in the non-PCT group in the same hospital, and 44.7% in the non-PCT group in other hospitals. Patients in the PCT group had lower odds of receiving antibiotics in the first 7 days of admission (OR, 0.33; 95% CI, 0.16-0.66 compared with the same hospital; OR, 0.42; 95% CI, 0.28-0.62 compared with the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was 35.2%, 43.9%, and 54.5%, respectively. The PCT group had lower odds of receiving antibiotics during the total admission only when compared with the other hospitals (OR, 0.23; 95% CI, 0.08-0.63). There were no significant differences in other secondary end points, except for readmission in the PCT group vs the other hospitals group. Interpretation: PCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalized patients with COVID-19, without major safety concerns.
AB - Background: Despite the low rate of bacterial coinfection, antibiotics are very commonly prescribed in hospitalized patients with COVID-19. Research Question: Does the use of a procalcitonin (PCT)-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection? Study Design and Methods: In this multicenter cohort, three groups of patients with COVID-19 were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n = 216) and two control groups, consisting of patients from the same hospital (n = 57) and of patients from three similar hospitals (n = 486) without PCT measurements during the same period. The primary end point was antibiotic prescription in the first week of admission. Results: Antibiotic prescription during the first 7 days was 26.8% in the PCT group, 43.9% in the non-PCT group in the same hospital, and 44.7% in the non-PCT group in other hospitals. Patients in the PCT group had lower odds of receiving antibiotics in the first 7 days of admission (OR, 0.33; 95% CI, 0.16-0.66 compared with the same hospital; OR, 0.42; 95% CI, 0.28-0.62 compared with the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was 35.2%, 43.9%, and 54.5%, respectively. The PCT group had lower odds of receiving antibiotics during the total admission only when compared with the other hospitals (OR, 0.23; 95% CI, 0.08-0.63). There were no significant differences in other secondary end points, except for readmission in the PCT group vs the other hospitals group. Interpretation: PCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalized patients with COVID-19, without major safety concerns.
KW - COVID-19
KW - bacterial infection
KW - biomarkers
KW - pneumonia
KW - procalcitonin
UR - http://www.scopus.com/inward/record.url?scp=85167607547&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.chest.2023.04.032
DO - https://doi.org/10.1016/j.chest.2023.04.032
M3 - Article
C2 - 37116748
SN - 0012-3692
VL - 164
SP - 596
EP - 605
JO - Chest
JF - Chest
IS - 3
ER -