Hughes Stephen, Mughal Nabeela, Moore Luke S P
Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK.
Antibiotics (Basel). 2021 Sep 17;10(9):1119. doi: 10.3390/antibiotics10091119.
Antibacterial prescribing in patients presenting with COVID-19 remains discordant to rates of bacterial co-infection. Implementing diagnostic tests to exclude bacterial infection may aid reduction in antibacterial prescribing. (1) Method: A retrospective observational analysis was undertaken of all hospitalised patients with COVID-19 across a single-site NHS acute Trust (London, UK) from 1 December 2020 to 28 February 2021. Electronic patient records were used to identify patients, clinical data, and outcomes. Procalcitonin (PCT) serum assays, where available on admission, were analysed against electronic prescribing records for antibacterial prescribing to determine relationships with a negative PCT result (<25 mg/L) and antibacterial course length. (2) Results: Antibacterial agents were initiated on admission in 310/624 (49.7%) of patients presenting with COVID-19. A total of 33/74 (44.5%) patients with a negative PCT on admission had their treatment stopped within 24 h. A total of 6/49 (12.2%) patients were started on antibacterials, but a positive PCT saw their treatment stopped. Microbiologically confirmed bacterial infection was low (19/594; 3.2%) and no correlation was seen between PCT and culture positivity ( = 1). Lower mortality (15.6% vs. 31.4%; = 0.049), length of hospital stay (7.9 days vs. 10.1 days; = 0.044), and intensive care unit (ICU) admission (13.9% vs. 40.8%; = 0.001) was noted among patients with low PCT. (3) Conclusions: This retrospective analysis of community acquired COVID-19 patients demonstrates the potential role of PCT in excluding bacterial co-infection. A negative PCT on admission correlates with shorter antimicrobial courses, early cessation of therapy, and predicts lower frequency of ICU admission. Low PCT may support decision making in cessation of antibacterials at the 48-72 h review.
新冠肺炎患者的抗菌药物处方与细菌合并感染率仍不一致。开展诊断检测以排除细菌感染可能有助于减少抗菌药物处方。（1）方法：对2020年12月1日至2021年2月28日期间英国伦敦一家NHS急性信托单中心收治的所有新冠肺炎住院患者进行回顾性观察分析。利用电子病历识别患者、临床数据和结局。对入院时可用的降钙素原（PCT）血清检测结果与抗菌药物处方的电子处方记录进行分析，以确定与PCT阴性结果（<25mg/L）和抗菌药物疗程的关系。（2）结果：310/624（49.7%）的新冠肺炎患者在入院时开始使用抗菌药物。入院时PCT阴性的患者中，共有33/74（44.5%）在24小时内停止治疗。共有6/49（12.2%）的患者开始使用抗菌药物，但PCT阳性的患者其治疗被停止。微生物学确诊的细菌感染率较低（19/594；3.2%），且未观察到PCT与培养阳性之间的相关性（=1）。PCT水平较低的患者死亡率较低（15.6%对31.4%；=0.049）、住院时间较短（7.9天对10.1天；=0.044）以及重症监护病房（ICU）入院率较低（13.9%对40.8%；=0.001）。（3）结论：这项对社区获得性新冠肺炎患者的回顾性分析表明了PCT在排除细菌合并感染方面的潜在作用。入院时PCT阴性与抗菌药物疗程较短、治疗早期停止以及ICU入院频率较低相关。低PCT水平可能有助于在48 - 72小时复查时做出停用抗菌药物的决策。
