A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19.

Autor:	Sandoe JAT; Department of Microbiology, The General Infirmary at Leeds, Leeds, UK.; Healthcare Associated Infection Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK., Grozeva D; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Albur M; Department of Infection Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK., Bond SE; Pharmacy Department, Mid Yorkshire Teaching NHS Trust, Wakefield, UK., Brookes-Howell L; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Dark P; Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK., Euden J; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Hamilton R; Antibiotic Research UK, York, UK.; School of Pharmacy, De Montfort University, Leicester, UK., Hellyer TP; Royal Victoria Infirmary, Newcastle and Freeman Hospital, Newcastle-upon-Tyne Hospital NHS Foundation Trust, Newcastle-upon-Tyne, UK.; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK., Henley J; School of Social Sciences, Cardiff University, Cardiff, UK., Hopkins S; UK Health Security Agency, London, UK., Howard P; NHS England and NHS Improvement, North-East and Yorkshire Region, UK., Howdon D; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK., Knox-Macaulay C; Public and Patient Involvement Representative, Centre for Trials Research, Cardiff University, Cardiff, UK., Llewelyn MJ; Brighton and Sussex Medical School, University of Sussex and University Hospitals Sussex NHS Foundation Trust, Brighton, UK., Maboshe W; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., McCullagh IJ; Royal Victoria Infirmary, Newcastle and Freeman Hospital, Newcastle-upon-Tyne Hospital NHS Foundation Trust, Newcastle-upon-Tyne, UK.; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK., Ogden M; Public and Patient Involvement Representative, Centre for Trials Research, Cardiff University, Cardiff, UK., Parsons HK; Department of Microbiology, Laboratory Medicine, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., Partridge DG; Department of Microbiology, Laboratory Medicine, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., Powell N; Pharmacy Department, Royal Cornwall Hospitals NHS Foundation Trust, Truro, UK., Prestwich G; Public and Patient Involvement Representative, Centre for Trials Research, Cardiff University, Cardiff, UK., Shaw D; Leicester NIHR Biomedical Research Centre and Department of Respiratory Sciences, University of Leicester, Leicester, UK., Shinkins B; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK.; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Szakmany T; Critical Care Directorate, Aneurin Bevan University Health Board, Cwmbran, UK.; Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK., Thomas-Jones E; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK., Todd S; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK., West RM; Leeds Institute for Health Sciences, University of Leeds, Leeds, UK., Carrol ED; Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK., Pallmann P; Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2024 Nov 04; Vol. 79 (11), pp. 2792-2800.
DOI:	10.1093/jac/dkae246
Abstrakt:	Background: Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK. Objectives: Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups. Methods: Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020. Results: Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22-0.64 days, P < 0.001) and of 0.72 days (95% CI: 0.06-1.38 days, P = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections. Conclusions: Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility. Study Registration Number: ISRCTN66682918. (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
Databáze:	MEDLINE
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