降钙素原（PCT）作为细菌二重感染生物标志物的可靠性降低：对危重症COVID-19患者中PCT驱动的抗生素管理的担忧——来自重症监护病房的一项回顾性观察研究结果
Reduced Reliability of Procalcitonin (PCT) as a Biomarker of Bacterial Superinfection: Concerns about PCT-Driven Antibiotic Stewardship in Critically Ill COVID-19 Patients-Results from a Retrospective Observational Study in Intensive Care Units.
作者信息
Ceccarelli Giancarlo, Alessandri Francesco, Migliara Giuseppe, Baccolini Valentina, Giordano Giovanni, Galardo Gioacchino, Marzuillo Carolina, De Vito Corrado, Russo Alessandro, Ciccozzi Massimo, Villari Paolo, Venditti Mario, Mastroianni Claudio M, Pugliese Francesco, d'Ettorre Gabriella
机构信息
Hospital Policlinico Umberto I, 00161 Rome, Italy.
Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy.
出版信息
J Clin Med. 2023 Sep 24;12(19):6171. doi: 10.3390/jcm12196171.
BACKGROUND
The aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients.
METHODS
In this retrospective, observational study, all critically ill COVID-19 patients who survived for ≥2 days in a single university hospital and had at least one serum procalcitonin (PCT) value and associated blood culture and/or culture from a lower respiratory tract specimen available were eligible for the study.
RESULTS
Over the research period, 184 patients were recruited; 67 VAP/BSI occurred, with an incidence rate of 21.82 episodes of VAP/BSI (95% CI: 17.18-27.73) per 1000 patient-days among patients who were included. At the time of a positive microbiological culture, an average PCT level of 1.25-3.2 ng/mL was found. Moreover, also in subjects without positive cultures, PCT was altered in 21.7% of determinations, with an average value of 1.04-5.5 ng/mL. Both PCT and PCT-72 h were not linked to a diagnosis of VAP/BSI in COVID-19 patients, according to the multivariable GEE models (aOR 1.13, 95% CI 0.51-2.52 for PCT; aOR 1.32, 95% CI 0.66-2.64 for PCT-72 h).
CONCLUSION
Elevated PCT levels might not always indicate bacterial superinfections or coinfections in a severe COVID-19 setting.
背景
本研究的目的是评估降钙素原水平是否是一种诊断工具，即使在危重症 COVID-19 患者中也能准确识别脓毒症和呼吸机相关性肺炎（VAP）。
方法
在这项回顾性观察研究中，所有在一家大学医院存活≥2 天、有至少一个血清降钙素原（PCT）值以及相关血培养和/或下呼吸道标本培养结果的危重症 COVID-19 患者均符合研究条件。
结果
在研究期间，共招募了 184 名患者；发生了 67 例 VAP/血流感染（BSI），纳入患者中 VAP/BSI 的发生率为每 1000 患者日 21.82 例（95%置信区间：17.18 - 27.73）。在微生物培养结果呈阳性时，发现平均 PCT 水平为 1.25 - 3.2 ng/mL。此外，在培养结果未呈阳性的患者中，21.7%的检测结果显示 PCT 有变化，平均值为 1.04 - 5.5 ng/mL。根据多变量广义估计方程（GEE）模型，PCT 和 PCT - 72 小时均与 COVID-19 患者的 VAP/BSI 诊断无关（PCT 的调整后比值比为 1.13，95%置信区间为 0.51 - 2.52；PCT - 72 小时的调整后比值比为 1.32，95%置信区间为 0.66 - 2.64）。
结论
在重症 COVID-19 患者中，PCT 水平升高可能并不总是表明存在细菌重叠感染或混合感染。
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