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

Neil Powell,Iain J Mccullagh,Martin J Llewelyn,Emma Thomas-Jones,Helena Parsons,Thomas P Hellyer,Susan Hopkins,Stacy Todd,David G Partridge,Philip Pallmann,Philip Howard,Bethany Shinkins,Robert West,Paul Dark,Margaret Ogden,Joanne Euden,Enitan D Carrol ,Dominick Shaw ,Stuart Bond ,Mahableshwar Albur ,Lucy Brookes‐Howell ,Tamás Szakmany ,Jonathan Sandoe

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.

Highlights

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread as a global pandemic since late 2019
The majority of respondents reported that they thought PCT had a positive effect on controlling antibiotic overuse in COVID-19 patients with 78/114 (68.4%) responding with either “Yes somewhat” or “Yes very much”
The polar plot shows the percentage of respondents who felt PCT testing had been either very useful, somewhat useful, were not sure or not/probably not useful according to whether PCT had been used at their trust pre-COVID, within a guideline, as part of an order set, with a high cut-off (0.5 ng/L) and as non-single use in the Intensive Care Units (ICU) or AMU/ED setting

Summary

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread as a global pandemic since late 2019. Many hospitals adopted PCT during the first wave of COVID-19 (Figure 1A); 57/146 (39.0%) of ED/AMUs and 54/147 (36.7%) of ICUs. Most introduced testing in late March and early April as case numbers were increasing rapidly, and well before the publication of NICE rapid guidance NG173 on 1st May 2020.

Results

Conclusion