C 反应蛋白和降钙素原在 COVID-19 中的抗菌药物管理作用。
C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19.
机构信息
Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (BREATH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
出版信息
Infection. 2021 Oct;49(5):935-943. doi: 10.1007/s15010-021-01615-8. Epub 2021 May 22.
PURPOSE
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection.
METHODS
We performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated.
RESULTS
Out of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%.
CONCLUSION
PCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.
目的
由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）已在全球范围内传播。区分单纯病毒性 COVID-19 肺炎和继发感染具有一定挑战性。入院时 C 反应蛋白（CRP）升高的患者，医生通常会决定开具抗生素治疗。然而，为了防止抗菌药物耐药性的增加，应避免在大流行期间过度使用抗感染治疗。降钙素原（PCT）和 CRP 在其他下呼吸道感染中已被证明有用，并且可能有助于区分单纯病毒或继发感染。
方法
我们对 2020 年 3 月 6 日至 10 月 30 日期间因 COVID-19 入院的患者进行了回顾性研究。评估了患者的背景、临床病程、实验室检查结果，重点是 PCT 和 CRP 水平和微生物学结果。比较了有和无继发细菌感染的患者的 PCT 和 CRP。使用受试者工作特征（ROC）分析，计算了 PCT 和 CRP 的最佳鉴别截断值及其相应的灵敏度和特异性。
结果
99 例 COVID-19 住院患者（52 例 ICU，47 例非 ICU）中，32 例（32%）在住院期间发生继发细菌感染。继发细菌感染的患者入院时和住院期间 PCT（0.4 与 0.1ng/mL；p=0.016）和 CRP（131 与 73mg/L；p=0.001）水平更高，且住院期间 PCT（2.9 与 0.1ng/mL；p<0.001）和 CRP（293 与 94mg/L；p<0.001）水平更高。大多数普通病房患者（93%）无继发细菌感染。入住 ICU 的患者中，超过一半（56%）发生继发细菌感染。整个队列中，PCT 和 CRP 最高值与继发感染的 ROC 分析获得的 AUC 分别为 0.88（p<0.001）和 0.86（p<0.001）。以 PCT 截断值为 0.55ng/mL 时，灵敏度为 91%，特异性为 81%；以 CRP 截断值为 172mg/L 时，灵敏度为 81%，特异性为 76%。
结论
COVID-19 患者入院时和病程中 PCT 和 CRP 测量可能有助于识别继发细菌感染并指导抗生素治疗。
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