Use of procalcitonin for antibiotic stewardship in patients with COVID-19: A quality improvement project in a district general hospital | RCP Journals

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Fig 1.
Guideline for rationalising antibiotics in patients with suspected or confirmed COVID-19.
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Fig 2.
Flow chart of exclusion criteria for data analysis. PCT levels were excluded from ITU patients because in this setting PCT levels are checked repeatedly to assess for ventilator-associated pneumonia and/or infection severity rather than as a guide for antibiotic prescribing, and because the complexity and severity of illness risks confounding PCT levels to an extent where PCT might no longer be fit for purpose in the context of antibiotic stewardship.
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Fig 3.
Pie charts showing antibiotic outcomes for all confirmed COVID-19 cases in each procalcitonin category. In all cases where antibiotics were prescribed, the outcome following procalcitonin result (ie started, stopped, continued, escalated or de-escalated) is also shown.

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Table 1.

Recommendation of antibiotic use based on procalcitonin result

Procalcitonin <0.1 μg/L	Antibiotics strongly discouraged
Procalcitonin 0.1–0.24 μg/L	Antibiotics discouraged
Procalcitonin 0.25–0.49 μg/L	Antibiotics encouraged
Procalcitonin ≥0.5 μg/L	Antibiotics strongly encouraged

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Table 2.

Demographics of included cases

	Procalcitonin (PCT) levels (N=127)	COVID-PCR status
Sex
Men	70	Positive: 43 (61.4%) Negative: 27 (38.6%)
Women	57	Positive: 29 (50.9%) Negative: 28 (49.1%)
Clinical setting
Emergency department Ward	73 54
Procalcitonin (PCT) groups
PCT <0.25 μg/L	77	Positive: 40 (51.9%) Negative: 37 (48.1%)
0.1; 0.07–0.16 (median; interquartile range)
PCT 0.25–0.49 μg/L	18	Positive: 13 (72.2%) Negative: 5 (27.8%)
0.355; 0.30–0.385 (median; interquartile range)
PCT ≥0.5 μg/L	32	Positive: 19 (59.4%) Negative: 13 (40.6)
1.26; 0.785–3.27 (median; interquartile range)

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Table 3.

Antibiotic outcomes for patients with repeat procalcitonin levels

	First PCT, μg/L	Second PCT, μg/L	COVID-19 swab	Antibiotic outcome following PCT
Patient 1	0.11 (15 April 2020)^*	0.15 (22 April 2020)^*	POS POS	1st PCT: Stopped <24hrs 2nd PCT: Continued
Patient 2	0.05 (17 April 2020)^*	0.17 (20 April 2020)^*	POS POS	1st PCT: Stopped <24hrs 2nd PCT: No antibiotics
Patient 3	0.02 (12 April 2020)^*	0.11 (26 April 2020)^*	NEG POS	1st PCT: Stopped <24hrs 2nd PCT: De-escalated
Patient 4	0.08 (12 April 2020)^*	0.08 (27 April 2020)^*	NEG NEG	1st PCT: No antibiotics 2nd PCT: Started + escalated
Patient 5	0.1 (16 April 2020)^*	0.1 (17 April 2020)^*	NEG NEG	1st PCT: No antibiotics 2nd PCT: No antibiotics
Patient 6	0.2 (23 April 2020)^*	0.25 (26 April 2020)^†	POS POS	1st PCT: No antibiotics 2nd PCT: Started + continued
Patient 7	0.11 (25 April 2020)^*	0.8 (26 April 2020)^‡	POS POS	1st PCT: De-escalated 2nd PCT: Continued
Patient 8	0.26 (17 April 2020)^†	0.21 (20 April 2020)^*	POS POS	1st PCT: Continued 2nd PCT: Stopped <24hrs
Patient 9	0.65 (18 April 2020)^‡	0.37 (22 April 2020)^†	POS POS	1st PCT: Continued 2nd PCT: De-escalated

↵^*Low procalcitonin group;
↵^†mid-range procalcitonin group;
↵^‡high procalcitonin group. NEG = negative, POS = positive.

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