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. 2023 Apr 5;12(4):709.
doi: 10.3390/antibiotics12040709.

Procalcitonin Values Fail to Track the Presence of Secondary Bacterial Infections in COVID-19 ICU Patients

Elsa Harte  1 , Sharuha Kumarasamysarma  1 , Benjamin Phillips  1 , Olivia Mackay  1 , Zohra Rashid  1 , Natalya Malikova  1 , Abdullah Mukit  1 , Saraswathi Ramachandran  1 , Anna Biju  1 , Kate Brown  1 , Rosie Watts  1 , Charlie Hodges  1 , William Tuckwell  1 , Nick Wetherall  1 , Henry Breen  1 , Shannon Price  1 , Tamas Szakmany  2   3
Affiliations

Procalcitonin Values Fail to Track the Presence of Secondary Bacterial Infections in COVID-19 ICU Patients

Elsa Harte et al. Antibiotics (Basel). .

Abstract

The development of secondary bacterial infections in COVID-19 patients has been associated with increased mortality and worse clinical outcomes. Consequently, many patients have received empirical antibiotic therapies with the potential to further exacerbate an ongoing antimicrobial resistance crisis. The pandemic has seen a rise in the use of procalcitonin testing to guide antimicrobial prescribing, although its value remains elusive. This single-centre retrospective study sought to analyse the efficacy of procalcitonin in identifying secondary infections in COVID-19 patients and evaluate the proportion of patients prescribed antibiotics to those with confirmed secondary infection. Inclusion criteria comprised patients admitted to the Grange University Hospital intensive care unit with SARS-CoV-2 infection throughout the second and third waves of the pandemic. Data collected included daily inflammatory biomarkers, antimicrobial prescriptions, and microbiologically proven secondary infections. There was no statistically significant difference between PCT, WBC, or CRP values in those with an infection versus those without. A total of 57.02% of patients had a confirmed secondary infection, with 80.2% prescribed antibiotics in Wave 2, compared to 44.07% with confirmed infection and 52.1% prescribed antibiotics in Wave 3. In conclusion, procalcitonin values failed to indicate the emergence of critical care-acquired infection in COVID-19 patients.

Keywords: COVID-19; antibiotics; antimicrobial stewardship; immunomodulators; procalcitonin; secondary infection.

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Conflict of interest statement

Prof Szakmany has received speaking fees from ThermoFisher Scientific Ltd., Altrincham, UK The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Prevalence of Pathogens Detected by Blood Cultures and Sputum Cultures (see Appendix A for Microbiology KEY).
Figure 2
Figure 2
Comparison of Procalcitonin (PCT) Levels in Infection Group and No Infection Group. Violin plots represent the distribution of data. Hard lines show medians, and dashed lines show interquartile ranges. The y-axis represents Procalcitonin Levels in ng/mL. The x-axis represents Days in the Intensive Care Unit (ICU) with 0—Procalcitonin Level Day 0. ns—no statistically significant difference from the Independent Mann–Whitney U test or one-way analysis of variances (ANOVA).
Figure 3
Figure 3
Comparison of white blood cell (WBC) count in the Infection Group and No Infection Group. Violin plots represent the distribution of data. Hard lines show medians, and dashed lines show interquartile ranges. The y-axis represents white blood cell count in 109/L. The x-axis represents Days in the Intensive Care Unit (ICU) with 0—white blood cell count Day 0. ns—no statistically significant difference from the independent Mann–Whitney U test.
Figure 4
Figure 4
Comparison of C-reactive protein (CRP) levels in Infection Group and No Infection Group. Violin plots represent the distribution of data. Hard lines show medians, and dashed lines show interquartile ranges. The y-axis represents C-reactive protein (CRP) levels in mg/L. The x-axis represents Days in the Intensive Care Unit (ICU) with 0—C-reactive protein level Day 0. ns—no statistically significant difference from the Independent Mann–Whitney U test.
Figure 5
Figure 5
Comparison of Sequential Organ Failure Assessment (SOFA) scores in Infection Group and No Infection Group. Violin plots represent the distribution of data. Hard lines show medians, and dashed lines show interquartile ranges. The y-axis represents SOFA Scores in Days. The x-axis represents Days in the Intensive Care Unit (ICU) with 0—SOFA Score Day 0. ns—no statistically significant difference from the Independent Mann–Whitney U test. p < 0.05 indicates statistical significance.
Figure 6
Figure 6
Histogram showing antibiotic/antimicrobial density during (A) Wave 2 and (B) Wave 3.
Figure 7
Figure 7
Line graph contrasting the length of antibiotic/antimicrobial therapy and length of Intensive Care Unit (ICU) stay for each patient during (A) Wave 2 and (B) Wave 3.
Figure 8
Figure 8
Table showing the frequency of each initial antimicrobial from both waves.
See this image and copyright information in PMC

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