Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Hong Kong SAR, China.
Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China.
BMC Infect Dis. 2024 Jan 19;24(1):106. doi: 10.1186/s12879-023-08849-x.
Bacterial infections are not prevalent among patients hospitalized with COVID-19, while unnecessary prescription of antibiotics was commonly observed. This study aimed to determine the impact of procalcitonin testing on antibiotics prescription in the real-world setting.
We performed a territory-wide retrospective cohort study involving all laboratory-confirmed patients hospitalized in public hospitals in Hong Kong in 2020 with COVID-19. We determined the prevalence of bacterial co-infections (documented infections within 72 h of admission) and secondary bacterial infections (infections after 72 h of admission) and antibiotics consumption, and the correlation between procalcitonin testing and antibiotics prescription.
The cohort included 8666 patients, with mean age 45.3 ± 19.9 years, 48.5% male, and comorbidities in 26.9%. Among 2688 patients with bacterial cultures performed, 147 (5.5%) had bacterial co-infections, and 222 (8.3%) had secondary bacterial infections. Antibiotics were prescribed for 2773 (32.0%) patients during the hospital admission. Procalcitonin tests were performed for 2543 (29.3%) patients. More patients with procalcitonin testing received antibiotics (65.9% vs. 17.9%, p < 0.001). Procalcitonin testing was associated with 5-fold increased risk of antibiotics prescription after adjusting for confounding variables. At hospital level, procalcitonin testing correlated with antibiotics prescription. Patients with procalcitonin level < 0.5 ng/mL had a lower probability of antibiotics initiation and shorter duration of antibiotics therapy.
Procalcitonin testing was not associated with lower prescription of antibiotics. Patients with low procalcitonin level had lower antibiotics exposure, supporting the use of procalcitonin to exclude bacterial infections aiding early stopping of antibiotics among patients hospitalized with COVID-19.
COVID-19 住院患者中细菌感染并不常见，而抗生素的不必要处方却很常见。本研究旨在确定降钙素原检测对现实环境中抗生素处方的影响。
我们进行了一项全港范围的回顾性队列研究，纳入了 2020 年在香港公立医院住院的所有经实验室确诊的 COVID-19 患者。我们确定了细菌合并感染（入院后 72 小时内确诊的感染）和继发性细菌感染（入院后 72 小时后感染）的发生率以及抗生素的使用情况，并确定了降钙素原检测与抗生素处方之间的相关性。
该队列包括 8666 名患者，平均年龄为 45.3±19.9 岁，48.5%为男性，合并症发生率为 26.9%。在进行细菌培养的 2688 名患者中，147 名（5.5%）有细菌合并感染，222 名（8.3%）有继发性细菌感染。在住院期间，2773 名（32.0%）患者开具了抗生素。2543 名（29.3%）患者进行了降钙素原检测。进行降钙素原检测的患者接受抗生素治疗的比例更高（65.9% vs. 17.9%，p<0.001）。在调整了混杂因素后，降钙素原检测与抗生素处方的相关性仍存在。在医院层面，降钙素原检测与抗生素处方相关。降钙素原水平<0.5ng/ml 的患者开始使用抗生素的可能性较低，抗生素治疗的持续时间较短。
降钙素原检测与抗生素处方的减少无关。降钙素原水平较低的患者抗生素暴露较少，支持使用降钙素原排除 COVID-19 住院患者的细菌感染，以帮助早期停止使用抗生素。
