Browse by author
Lookup NU author(s): Dr Tom Hellyer, Dr Ian McCullagh
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.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.
Author(s): Sandoe JAT, Grozeva D, Albur M, Bond SE, Brookes-Howell L, Dark P, Euden J, Hamilton R, Hellyer TP, Henley J, Hopkins S, Howard P, Howdon D, Knox-Macaulay C, Llewelyn MJ, Maboshe W, McCullagh IJ, Ogden M, Parsons HK, Partridge DG, Powell N, Prestwich G, Shaw D, Shinkins B, Szakmany T, Thomas-Jones E, Todd S, West RM, Carrol ED, Pallmann P
Publication type: Article
Publication status: Published
Journal: Journal of Antimicrobial Chemotherapy
Year: 2024
Volume: 79
Issue: 11
Pages: 2792-2800
Print publication date: 01/11/2024
Online publication date: 09/09/2024
Acceptance date: 14/06/2024
Date deposited: 18/11/2024
ISSN (print): 0305-7453
ISSN (electronic): 1460-2091
Publisher: Oxford University Press
URL: https://doi.org/10.1093/jac/dkae246
DOI: 10.1093/jac/dkae246
Data Access Statement: This work was done under the ‘COPI Notice’ issued under Regulation 3(4) and the corresponding transition to Section 5 of the Health Service (Control of Patient Information) Regulations 2002 to allow processing of confidential patient information without consent. As a result, we cannot make the underlying dataset publicly available for ethical and legal reasons. However, all the data used for this analysis are held as aggregated data by the Centre for Trials Research at Cardiff University. Requests for access to relevant anonymized data should be submitted to the Centre for Trials Research at PEACH@cardiff.ac.uk. It should be noted that within the remits of Condition 1 of the Health Service Regulations, sensitive information cannot be shared. All data releases are subject to receipt of a signed sample and data application form and internal assessment and approval for data release. More at https://academic.oup.com/jac/article/79/11/2792/7753440#491491706
PubMed id: 39248146
Altmetrics provided by Altmetric
