Use of Procalcitonin during the First Wave of COVID-19 in the Acute NHS Hospitals: A Retrospective Observational Study

Neil Powell¹, Philip Howard^{2

3}, Martin J Llewelyn⁴, Tamas Szakmany^{5

6}, Mahableswhar Albur⁷, Stuart E Bond^{8

9}, Joanne Euden¹⁰, Lucy Brookes-Howell¹⁰, Paul Dark¹¹, Thomas P Hellyer¹², Susan Hopkins¹³, Iain J McCullagh¹⁴, Margaret Ogden¹⁵, Philip Pallmann¹⁰, Helena Parsons¹⁶, David G Partridge¹⁶, Dominick E Shaw¹⁷, Bethany Shinkins¹⁸, Stacy Todd¹⁹, Emma Thomas-Jones¹⁰, Robert West²⁰, Enitan D Carrol²¹, Jonathan A T Sandoe²²

Affiliations

¹ Pharmacy Department, Royal Cornwall Hospital Trust, Truro TR1 3LJ, UK.
² School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
³ Department of Medicines Management and Pharmacy, Leeds Teaching Hospitals, Leeds General Infirmary, Leeds LS1 3EX, UK.
⁴ Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PS, UK.
⁵ Grange University Hospital, Aneurin Bevan University Health Board, Llanyravon, Cwmbran NP44 2XJ, UK.
⁶ Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK.
⁷ North Bristol NHS Trust, Bristol BS10 5NB, UK.
⁸ Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK.
⁹ School of Applied Sciences, University of Huddersfield, Huddersfield HD13DH, UK.
¹⁰ Centre for Trials Research, Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff CF14 4YS, UK.
¹¹ Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester M13 9PL, UK.
¹² Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK.
¹³ Public Health England, London SE1 8UG, UK.
¹⁴ The Newcastle upon Tyne hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK.
¹⁵ Patient and Public Involvement Representative, NIHR, London SW1A 2NS, UK.
¹⁶ Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK.
¹⁷ Division of Respiratory Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
¹⁸ Test Evaluation Group, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK.
¹⁹ Liverpool University Hospital NHS Foundation Trust, Liverpool L9 7AL, UK.
²⁰ Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9TJ, UK.
²¹ Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK.
²² Healthcare Associated Infection Group, Leeds Institute of Medical Research, School of Medicine, University of Leeds, LS2 9JT, UK.

PMID: 34062898
PMCID: PMC8147337
DOI: 10.3390/antibiotics10050516

Use of Procalcitonin during the First Wave of COVID-19 in the Acute NHS Hospitals: A Retrospective Observational Study

Neil Powell et al. Antibiotics (Basel). 2021.

. 2021 May 1;10(5):516.

doi: 10.3390/antibiotics10050516.

Authors

Affiliations

¹ Pharmacy Department, Royal Cornwall Hospital Trust, Truro TR1 3LJ, UK.
² School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
³ Department of Medicines Management and Pharmacy, Leeds Teaching Hospitals, Leeds General Infirmary, Leeds LS1 3EX, UK.
⁴ Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PS, UK.
⁵ Grange University Hospital, Aneurin Bevan University Health Board, Llanyravon, Cwmbran NP44 2XJ, UK.
⁶ Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK.
⁷ North Bristol NHS Trust, Bristol BS10 5NB, UK.
⁸ Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK.
⁹ School of Applied Sciences, University of Huddersfield, Huddersfield HD13DH, UK.
¹⁰ Centre for Trials Research, Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff CF14 4YS, UK.
¹¹ Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester M13 9PL, UK.
¹² Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK.
¹³ Public Health England, London SE1 8UG, UK.
¹⁴ The Newcastle upon Tyne hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK.
¹⁵ Patient and Public Involvement Representative, NIHR, London SW1A 2NS, UK.
¹⁶ Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK.
¹⁷ Division of Respiratory Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
¹⁸ Test Evaluation Group, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK.
¹⁹ Liverpool University Hospital NHS Foundation Trust, Liverpool L9 7AL, UK.
²⁰ Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9TJ, UK.
²¹ Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK.
²² Healthcare Associated Infection Group, Leeds Institute of Medical Research, School of Medicine, University of Leeds, LS2 9JT, UK.

PMID: 34062898
PMCID: PMC8147337
DOI: 10.3390/antibiotics10050516

Abstract

A minority of patients presenting to hospital with COVID-19 have bacterial co-infection. Procalcitonin testing may help identify patients for whom antibiotics should be prescribed or withheld. This study describes the use of procalcitonin in English and Welsh hospitals during the first wave of the COVID-19 pandemic. A web-based survey of antimicrobial leads gathered data about the use of procalcitonin testing. Responses were received from 148/151 (98%) eligible hospitals. During the first wave of the COVID-19 pandemic, there was widespread introduction and expansion of PCT use in NHS hospitals. The number of hospitals using PCT in emergency/acute admissions rose from 17 (11%) to 74/146 (50.7%) and use in Intensive Care Units (ICU) increased from 70 (47.6%) to 124/147 (84.4%). This increase happened predominantly in March and April 2020, preceding NICE guidance. Approximately half of hospitals used PCT as a single test to guide decisions to discontinue antibiotics and half used repeated measurements. There was marked variation in the thresholds used for empiric antibiotic cessation and guidance about interpretation of values. Procalcitonin testing has been widely adopted in the NHS during the COVID-19 pandemic in an unevidenced, heterogeneous way and in conflict with relevant NICE guidance. Further research is needed urgently that assesses the impact of this change on antibiotic prescribing and patient safety.

Keywords: COVID-19; antibiotic; procalcitonin; stewardship.

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Conflict of interest statement

J.A.T.S. has current research funding relating to diagnostic testing from NIHR, MRC, EPSRC, Wellcome Trust, and Leeds Cares. Within the last 5 years, J.S. has been involved in research funded by Pfizer, Astellas, and Merck Sharp and Dohme. N.P. has received honoraria from Thermofisher. P.D. is ADAPT sepsis Chief Investigator. M.J.L., J.E., P.H., S.T. are investigators on PRONTO. M.A. has received lecturing fees from Pfizer, and lecturing fees from Shionogi, H.D.R. U.K. P.P. E.C. E.T.J. investigators on PRONTO, BATCH, PRECISE. T.H. I.M., investigators on ADAPT (RISC-sepsis) B.S. supported by the NIHR In Vitro diagnostics Co-operative. T.S., D.P., S.B., M.O., H.P., D.S., R.W., L.B.H., S.H. none to declare.

Figures

**Figure 1**
Changed use of PCT testing at acute NHS hospitals in England and Wales. (A) Weekly number of hospitals using procalcitonin (PCT) on intensive care unit (ICU) (-•-) and Emergency Department (ED)/Acute Medical Unit (AMU) (-•-). For reference, the time course of the COVID-19 pandemic first wave in England is shown as weekly number of PCR positive cases (-). NG173 = National Institute for Health and Care Excellence (NICE) COVID-19 rapid guideline NG173: [9] Data extracted from Public Health England (PHE) national COVID surveillance reports available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/916994/COVID19_Weekly_Report_09_September_2020.pdf (accessed on 21 February 2021). (B). Breakdown of changes in PCT use on ICU and ED/AMU at 148 hospitals over the course of the pandemic first wave.

**Figure 2**
Perceived usefulness of procalcitonin (PCT) in relation to how it was used in practice.

See this image and copyright information in PMC

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Use of Procalcitonin during the First Wave of COVID-19 in the Acute NHS Hospitals: A Retrospective Observational Study

Affiliations

Use of Procalcitonin during the First Wave of COVID-19 in the Acute NHS Hospitals: A Retrospective Observational Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Full Text Sources

Miscellaneous