Powell Neil, Howard Philip, Llewelyn Martin J, Szakmany Tamas, Albur Mahableswhar, Bond Stuart E, Euden Joanne, Brookes-Howell Lucy, Dark Paul, Hellyer Thomas P, Hopkins Susan, McCullagh Iain J, Ogden Margaret, Pallmann Philip, Parsons Helena, Partridge David G, Shaw Dominick E, Shinkins Bethany, Todd Stacy, Thomas-Jones Emma, West Robert, Carrol Enitan D, Sandoe Jonathan A T
Pharmacy Department, Royal Cornwall Hospital Trust, Truro TR1 3LJ, UK.
School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
Antibiotics (Basel). 2021 May 1;10(5):516. doi: 10.3390/antibiotics10050516.
A minority of patients presenting to hospital with COVID-19 have bacterial co-infection. Procalcitonin testing may help identify patients for whom antibiotics should be prescribed or withheld. This study describes the use of procalcitonin in English and Welsh hospitals during the first wave of the COVID-19 pandemic. A web-based survey of antimicrobial leads gathered data about the use of procalcitonin testing. Responses were received from 148/151 (98%) eligible hospitals. During the first wave of the COVID-19 pandemic, there was widespread introduction and expansion of PCT use in NHS hospitals. The number of hospitals using PCT in emergency/acute admissions rose from 17 (11%) to 74/146 (50.7%) and use in Intensive Care Units (ICU) increased from 70 (47.6%) to 124/147 (84.4%). This increase happened predominantly in March and April 2020, preceding NICE guidance. Approximately half of hospitals used PCT as a single test to guide decisions to discontinue antibiotics and half used repeated measurements. There was marked variation in the thresholds used for empiric antibiotic cessation and guidance about interpretation of values. Procalcitonin testing has been widely adopted in the NHS during the COVID-19 pandemic in an unevidenced, heterogeneous way and in conflict with relevant NICE guidance. Further research is needed urgently that assesses the impact of this change on antibiotic prescribing and patient safety.
少数因新冠肺炎入院的患者存在细菌合并感染。降钙素原检测可能有助于确定应使用或停用抗生素的患者。本研究描述了在新冠疫情第一波期间，降钙素原在英格兰和威尔士医院的使用情况。一项针对抗菌药物负责人的网络调查收集了有关降钙素原检测使用情况的数据。151家符合条件的医院中有148家（98%）回复了调查。在新冠疫情第一波期间，英国国民医疗服务体系（NHS）医院广泛引入并扩大了降钙素原的使用。在急诊/急性入院中使用降钙素原的医院数量从17家（11%）增至74/146家（50.7%），在重症监护病房（ICU）的使用从70家（47.6%）增至124/147家（84.4%）。这种增加主要发生在2020年3月和4月，早于英国国家卫生与临床优化研究所（NICE）的指南。约一半的医院将降钙素原作为单一检测来指导抗生素停药决策，另一半则使用重复测量。在经验性抗生素停药的阈值以及结果解读指南方面存在显著差异。在新冠疫情期间，降钙素原检测在英国国民医疗服务体系中以无证据、不统一的方式被广泛采用，且与相关的NICE指南相冲突。迫切需要进一步研究来评估这一变化对抗生素处方和患者安全的影响。
