Christensen Ingrid, Berild Dag, Bjørnholt Jørgen Vildershøj, Jelsness-Jørgensen Lars-Petter, Debes Sara Molvig, Haug Jon Birger
Østfold Hospital Trust, Department of Infection Control, 1714 Kalnes, Norway.
PhD Program Medicine and Health Sciences, Faculty of Medicine, University of Oslo, 1072 Oslo, Norway.
Antibiotics (Basel). 2023 Mar 14;12(3):573. doi: 10.3390/antibiotics12030573.
Up to 60% of the antibiotics prescribed to patients hospitalized with seasonal influenza are unnecessary. Procalcitonin (PCT) has the potential as an antimicrobial stewardship program (ASP) tool because it can differentiate between viral and bacterial etiology. We aimed to explore the role of PCT as an ASP tool in hospitalized seasonal influenza patients.
We prospectively included 116 adults with seasonal influenza from two influenza seasons, 2018-2020. All data was obtained from a single clinical setting and analyzed by descriptive statistics and regression models.
In regression analyses, we found a positive association of PCT with 30 days mortality and the amount of antibiotics used. Influenza diagnosis was associated with less antibiotic use if the PCT value was low. Patients with a low initial PCT (<0.25 µg/L) had fewer hospital and intensive care unit (ICU) days and fewer positive chest X-rays. PCT had a negative predictive value of 94% for ICU care stay, 98% for 30 days mortality, and 88% for bacterial coinfection.
PCT can be a safe rule-out test for bacterial coinfection. Routine PCT use in seasonal influenza patients with an uncertain clinical picture, and rapid influenza PCR testing, may be efficient as ASP tools.
因季节性流感住院的患者所使用的抗生素中，高达60%是不必要的。降钙素原（PCT）有潜力作为抗菌药物管理计划（ASP）的工具，因为它可以区分病毒和细菌病因。我们旨在探讨PCT作为ASP工具在季节性流感住院患者中的作用。
我们前瞻性纳入了2018 - 2020年两个流感季节的116例成年季节性流感患者。所有数据均来自单一临床环境，并通过描述性统计和回归模型进行分析。
在回归分析中，我们发现PCT与30天死亡率和抗生素使用量呈正相关。如果PCT值较低，流感诊断与较少的抗生素使用相关。初始PCT较低（<0.25µg/L）的患者住院天数和重症监护病房（ICU）天数较少，胸部X线阳性结果也较少。PCT对ICU住院的阴性预测值为94%，对30天死亡率的阴性预测值为98%，对细菌合并感染的阴性预测值为88%。
PCT可以作为细菌合并感染的安全排除检测方法。对于临床情况不确定的季节性流感患者常规使用PCT，以及快速流感PCR检测，可能作为有效的ASP工具。
