Procalcitonin Increase Is Associated with the Development of Critical Care-Acquired Infections in COVID-19 ARDS.

Owen Richards,Tamas Szakmany,Catherine Bailey,Charles King,Philip Pallmann,Emma Thomas-Jones,Jessica Harris,Yusuf Cheema,Charlotte Killick

doi:10.3390/antibiotics10111425

Owen Richards, Tamas Szakmany + Show 7 more

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https://doi.org/10.3390/antibiotics10111425

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Abstract

Secondary bacterial infection in COVID-19 patients is associated with increased mortality and disproportionately affects critically ill patients. This single-centre retrospective observational study investigates the comparative efficacy of change in procalcitonin (PCT) and other commonly available biomarkers in revealing or predicting microbiologically proven secondary infection in critical COVID-19 patients. Adult patients admitted to an intensive care unit (ICU) with confirmed SARS-CoV-2 infection between 9 March 2020 and 5 June 2020 were recruited to the study. For daily biomarker and secondary infection, laboratory-confirmed bloodstream infection (LCBI) and ventilator-associated pneumonia/tracheobronchitis (VAP/VAT) data were collected. We observed a PCT rise in 53 (81.5%) of the patients, a C-reactive protein (CRP) rise in 55 (84.6%) and a white blood cell count (WBC) rise in 61 (93.8%). Secondary infection was confirmed in 33 (50.8%) of the patients. A PCT rise was present in 97.0% of patients with at least one confirmed VAP/VAT and/or LCBI event. CRP and WBC rises occurred in 93.9% and 97.0% of patients with confirmed VAP/VAT and/or LCBI, respectively. Logistic regression analysis found that, when including all biomarkers in the same model, there was a significant association between PCT rise and the occurrence of LCBI and/or VAP/VAT (OR = 14.86 95%CI: 2.20, 342.53; p = 0.021). Conversely, no statistically significant relationship was found between either a CRP rise (p = 0.167) or a WBC rise (p = 0.855) and the occurrence of VAP/VAT and/or LCBI. These findings provide a promising insight into the usefulness of PCT measurement in predicting the emergence of secondary bacterial infection in ICU.

Highlights

Coronavirus disease 2019 (COVID-19) has been implicated in over four million deaths worldwide since its emergence in late 2019 [1]
Our finding, which confirmed that VAP/VAT and/or laboratory-confirmed bloodstream infection (LCBI) were significantly associated with a prespecified rise in PCT but not with a rise in C-reactive protein (CRP) or white blood cell count (WBC), suggests that serial PCT measurements could become useful in predicting the emergence of secondary bacterial infection in critical COVID-19 patients
The significant association we have shown between a PCT rise and intensive care unit (ICU)-acquired infection reinforces the potential of using PCT as part of an algorithm to initiate antimicrobial therapy to treat nosocomial infections in the context of a primary viral pathogen-induced acute respiratory failure [37]

Summary

Introduction

Coronavirus disease 2019 (COVID-19) has been implicated in over four million deaths worldwide since its emergence in late 2019 [1]. Concurrent bacterial infection in a critically ill patient can compound this complexity; early and accurate recognition of secondary pathogens is imperative in effectively managing an already unpredictable disease. Procalcitonin (PCT) is a biomarker with efficacy in differentiating bacterial from viral pneumonia [3], and serum levels correlate with infection severity [4]. Secondary bacterial infection in COVID-19 patients is associated with increased mortality [5,6] and disproportionately affects critically ill patients [7,8]. No data currently demonstrate the value of dynamic PCT changes in the presence or absence of confirmed secondary infection in COVID-19 patients [10], illustrating the urgent need for further research to allow for the formulation of a usable algorithm

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