University of Michigan Medical School, Ann Arbor, Michigan.
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Infect Control Hosp Epidemiol. 2023 Aug;44(8):1314-1320. doi: 10.1017/ice.2022.262. Epub 2022 Nov 4.
To describe the natural course of procalcitonin (PCT) in patients with coronavirus disease 2019 (COVID-19) and the correlation between PCT and antimicrobial prescribing to provide insight into best practices for PCT data utilization in antimicrobial stewardship in this population.
Single-center, retrospective, observational study.
Michigan Medicine.
Inpatients aged ≥18 years hospitalized March 1, 2020, through October 31, 2021, who were positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2), with ≥1 PCT measurement. Exclusion criteria included antibiotics for nonpulmonary bacterial infection on admission, treatment with azithromycin only for chronic obstructive pulmonary disease (COPD) exacerbation, and pre-existing diagnosis of cystic fibrosis with positive respiratory cultures.
A structured query was used to extract data. For patients started on antibiotics, bacterial pneumonia (bPNA) was determined through chart review. Multivariable models were used to assess associations of PCT level and bPNA with antimicrobial use.
Of 793 patients, 224 (28.2%) were initiated on antibiotics: 33 (14.7%) had proven or probable bPNA, 125 (55.8%) had possible bPNA, and 66 (29.5%) had no bPNA. Patients had a mean of 4.1 (SD, ±5.2) PCT measurements if receiving antibiotics versus a mean of 2.0 (SD, ±2.6) if not. Initial PCT level was highest for those with proven/probable bPNA and was associated with antibiotic initiation (odds ratio 95% confidence interval [CI], 1.17-1.30). Initial PCT (rate ratio [RR] 95% CI, 1.01-1.08), change in PCT over time (RR 95% CI, 1.01-1.05), and bPNA group (RR 95% CI, 1.23-1.84) were associated with antibiotic duration.
PCT trends are associated with the decision to initiate antibiotics and duration of treatment, independent of bPNA status and comorbidities. Prospective studies are needed to determine whether PCT level can be used to safely make decisions regarding antibiotic treatment for COVID-19.
描述新型冠状病毒肺炎（COVID-19）患者降钙素原（PCT）的自然病程，以及 PCT 与抗菌药物处方之间的相关性，为 COVID-19 患者抗菌药物管理中 PCT 数据应用的最佳实践提供参考。
单中心、回顾性、观察性研究。
密歇根大学医学中心。
2020 年 3 月 1 日至 2021 年 10 月 31 日期间住院、年龄≥18 岁的因严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）检测呈阳性且至少有 1 次 PCT 检测值的患者，排除标准包括入院时因非肺部细菌感染而使用抗生素、仅因慢性阻塞性肺疾病（COPD）加重而使用阿奇霉素治疗以及存在阳性呼吸道培养的囊性纤维化的预诊断。
使用结构化查询提取数据。对于开始使用抗生素的患者，通过病历回顾确定细菌性肺炎（bPNA）。使用多变量模型评估 PCT 水平和 bPNA 与抗菌药物使用的关联。
793 例患者中，224 例（28.2%）开始使用抗生素：33 例（14.7%）有确诊或疑似细菌性肺炎，125 例（55.8%）有疑似细菌性肺炎，66 例（29.5%）无细菌性肺炎。接受抗生素治疗的患者平均有 4.1（标准差，±5.2）次 PCT 测量值，而未接受抗生素治疗的患者平均有 2.0（标准差，±2.6）次 PCT 测量值。有确诊/疑似细菌性肺炎的患者初始 PCT 水平最高，且与抗生素的使用相关（优势比 95%置信区间[CI]，1.17-1.30）。初始 PCT（率比[RR]95%CI，1.01-1.08）、随时间变化的 PCT 变化（RR 95%CI，1.01-1.05）和 bPNA 分组（RR 95%CI，1.23-1.84）与抗生素的使用时间相关。
PCT 趋势与抗生素治疗的决策和治疗时间相关，独立于 bPNA 状态和合并症。需要前瞻性研究来确定 PCT 水平是否可用于 COVID-19 患者的安全抗生素治疗决策。
