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

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.

Metadata

Item Type:	Article
Authors/Creators:	Sandoe, J.A.T. https://orcid.org/0000-0003-0193-8677 Grozeva, D. https://orcid.org/0000-0003-3239-8415 Albur, M. Bond, S.E. https://orcid.org/0000-0001-9640-2474 Brookes-Howell, L. Dark, P. https://orcid.org/0000-0003-3309-0164 Euden, J. https://orcid.org/0000-0002-2844-6878 Hamilton, R. Hellyer, T.P. Henley, J. Hopkins, S. Howard, P. https://orcid.org/0000-0002-5096-0240 Howdon, D. Knox-Macaulay, C. Llewelyn, M.J. Maboshe, W. McCullagh, I.J. Ogden, M. Parsons, H.K. Partridge, D.G. https://orcid.org/0000-0002-0417-2016 Powell, N. https://orcid.org/0000-0002-6113-9810 Prestwich, G. Shaw, D. Shinkins, B. Szakmany, T. Thomas-Jones, E. Todd, S. West, R.M. Carrol, E.D. Pallmann, P. Sandoe, J. Carrol, E. Thomas-Jones, E. Euden, J. Brookes-Howell, L. Henley, J. Maboshe, W. Pallmann, P. Grozeva, D. Bargiel, M. Evans, J. Webb, E. Bestwick, R. Howdon, D. King, N. Shinkins, B. West, R. Richman, C. Gerver, S. Hope, R. Hopkins, S. Heginbothom, M. Howard, P. Sandoe, J. Berry, C. Davis, G. Wilkinson, V. Todd, S. Taylor-Barr, E. Brodsky, M. Brown, J. Burns, J. Glynn, S. Gureviciute, A. Howard, M. Kirkpatrick, J. Muphy, H. Richardson, E. Scanlon, D. Small, C. Sweeney, G. Williams, L. Szakmany, T. Baker, E. Cheema, Y. Dunhill, J. Killick, C. King, C. Kooner, S. Lewis, S. Nash, M. Richardson, O. Tuffney, J. Westacott, C. Williams, S. Partridge, D. Parsons, H. Cawthron, K. Tai, Y.K. Newman, T. Plowright, M. Shulver, H. Sivakova, A. Powell, N. Ayliffe, F. Darke, E. Fletcher, E. Hammonds, F. Marquez, G. Welch, L. Bond, S. Lee-Milner, J. Spencer, J. Albur, M. Brandao, R. Hrycaiczuk, J. Stanley, J. Llewelyn, M. Cross, E. Hansen, D. Redmore, E. Whyte, A. Hellyer, T. McCullagh, I. Brown, B. Calabrese, M. Cole, C. DeSousa, J. Dunn, L. Grieveson, S. Gulati, A. Issac, E. Mackay, R. Simoes, F. Dark, P. Apatri, E. Charles, B. Christensen, H. Harvey, A. Lomas, D. Taylor, M. Thomas, V. Walker, D. Shaw, D. Howard, L. Joseph, A. Sultan, S. Knox-Macaulay, C. Ogden, M. Prestwich, G. Hamilton, R.
Copyright, Publisher and Additional Information:	© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords:	PEACH Study Group
Dates:	Published: November 2024 Published (online): 9 September 2024 Accepted: 14 June 2024
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health
Depositing User:	Symplectic Sheffield
Date Deposited:	14 Oct 2024 11:13
Last Modified:	25 Feb 2025 11:31
Status:	Published
Publisher:	Oxford University Press (OUP)
Refereed:	Yes
Identification Number:	10.1093/jac/dkae246
Related URLs:	PubMed URL
Sustainable Development Goals:
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:218262

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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

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