Procalcitonin-Guided Treatment Protocol Reduces Antibiotic Use in COVID-19

A procalcitonin-guided treatment protocol was found to be safe for reducing antibiotic prescription rates among patients hospitalized with COVID-19 infection. These study results were published in Chest.

This multicenter, observational cohort study was conducted among patients with COVID-19 infection at a large teaching hospital (group 1) in the Netherlands between October 2020 and July 2021. Data for this analysis were also retrospectively sourced from the COVIDPredict study, a multicenter initiative comprising patients hospitalized with COVID-19 infection at 11 other hospitals (groups 2 and 3). Researchers assessed the use of a procalcitonin-guided antibiotic treatment protocol for safely reducing antibiotic prescription rates among 3 patient groups. Patients in group 1 received antibiotics based on the procalcitonin-guided treatment protocol, and those in groups 2 and 3 (controls) received antibiotic therapy without procalcitonin-based guidance.

The primary outcome was the rate of antibiotics prescribed within the first 7 days of admission. Logistic regression was used to compare rates of antibiotic use between the groups, with adjustments for confounding variables.

Among patients in groups 1 (n=216), 2 (n=57), and 3 (n=486), the median age was 68 (IQR, 57-78) years, 62.6% were men, and 92.1%, 80.7%, and 70.1% received corticosteroids during admission, respectively.

The rate of active or former smokers was significantly higher among patients in group 1 (45.8%) compared with those in groups 2 (31.6%) and 3 (39.3%). Patients in group 1 vs those in groups 2 and 3 also had significantly higher C-reactive protein levels (91 mg/L vs 57 mg/L and 76 mg/L, respectively) and significantly lower leukocyte counts (5.7×10⁹/L vs 6.1×10⁹/L and 7.3×10⁹/L, respectively) on hospital admission. In addition, patients in groups 1, 2, and 3 significantly differed in regard to rates of chronic obstructive pulmonary disease (10.6%, 8.8%, and 21.7%, respectively), diabetes (16.2%, 26.3%, and 31.2%, respectively), and congestive heart failure (7.4%, 8.8%, and 5.6%, respectively).

During the first 7 days of hospital admission, the highest rate of antibiotic prescriptions was noted among patients in group 1 (44.7%), followed by those in groups 2 (43.9%) and 3 (26.8%). The most frequently prescribed antibiotics included ceftriaxone, cefuroxime, and amoxicillin.

In the adjusted analysis, the lowest odds of receiving antibiotics within the first 7 days of admission was observed among patients in group 1 when compared with those in groups 2 (adjusted odds ratio [aOR], 0.33; 95% CI, 0.16-0.66) and 3 (aOR, 0.42; 95% CI, 0.28-0.62).

Further analysis among patients admitted to different hospitals showed that procalcitonin-guided treatment resulted in reduced odds of receiving antibiotics during the total duration of hospitalization. However, for patients at the same hospital, the odds of receiving antibiotics during the total duration of hospitalization did not significantly differ between those who did vs did not adhere to the procalcitonin-guided treatment protocol.

Rates of 30- and 90-day survival did not significantly differ between the 3 groups, including after adjustment for potential confounders. There also were no significant between-group differences in the odds of intensive care unit admission and mechanical ventilation.

Limitations of this study include the retrospective study design and changes in standard care for COVID-19 infection that occurred throughout the pandemic. Further, data on the exact duration and dose of antibiotic therapy were not available for all patients, potentially causing information bias.

According to the researchers, “Our study supports that a procalcitonin-guided antibiotic prescription protocol can be safely implemented in clinical practice.”

This article originally appeared on Infectious Disease Advisor