Williams Anita, Repetto Ernestina, Lebbie Ishmael, Khalife Mohamad, Jensen Tomas Oestergaard
Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
Middle East Medical Unit, Médecins Sans Frontières, Beirut, Lebanon.
Antimicrob Steward Healthc Epidemiol. 2024 Sep 12;4(1):e129. doi: 10.1017/ash.2024.372. eCollection 2024.
The primary objectives of this study were to assess the usefulness of C-reactive protein (CRP) and procalcitonin (PCT) in the diagnosis of bacterial co-infections in coronavirus disease 2019 (COVID-19) and if their incorporation in antimicrobial stewardship (AMS) programs is safe and useful, stratified by severity of disease as level of care, intensive care unit (ICU) or non-ICU. Our secondary objectives were to identify cut-off values for antibiotic decision-making and identify reported results from low- and middle-income countries (LMICs).
A scoping review of published literature, adhering to the PRISMA statement for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines. The last search was performed in January 2024.
Fifty-nine studies were included in this scoping review: 20 studies reporting predictive values and/or sensitivity/specificity results for PCT, 8 reporting clear objectives on AMS, and 3 studies from LMICs.
In the context of non-ICU hospitalized COVID-19 patients in high-income countries, a PCT value below 0.25 mg/L can be a useful tool to rule out bacterial co-infection. The wide range of reported negative predictive values suggests that PCT should be interpreted in the context of other clinical findings. Our results do not support the use of CRP in the same manner as PCT. There is a clear need for more studies in LMICs.
本研究的主要目的是评估C反应蛋白（CRP）和降钙素原（PCT）在2019冠状病毒病（COVID-19）细菌合并感染诊断中的作用，以及将它们纳入抗菌药物管理（AMS）计划是否安全且有用，并按疾病严重程度分层，分为重症监护病房（ICU）或非ICU护理级别。我们的次要目的是确定抗生素决策的临界值，并确定低收入和中等收入国家（LMICs）报告的结果。
对已发表文献进行范围综述，遵循系统评价和Meta分析扩展的范围综述指南PRISMA声明。最后一次检索于2024年1月进行。
本范围综述纳入了59项研究：20项研究报告了PCT的预测值和/或敏感性/特异性结果，8项报告了关于AMS的明确目标，3项来自LMICs的研究。
在高收入国家非ICU住院的COVID-19患者中，PCT值低于0.25mg/L可作为排除细菌合并感染的有用工具。报告的阴性预测值范围广泛，表明PCT应结合其他临床发现进行解读。我们的结果不支持以与PCT相同的方式使用CRP。LMICs显然需要更多的研究。
