Impact of introducing procalcitonin testing on antibiotic usage in acute NHS hospitals during the first wave of COVID-19 in the UK: A controlled interrupted time series analysis of organization-level data

Martin J. Llewelyn, Detelina Grozeva, Philip Howard, Joanne Euden, Sarah M. Gerver, Russell Hope, Margaret Heginbothom, Neil Powell, Colin Richman, Dominick Shaw, Emma Thomas-Jones, Robert M. West, Enitan D. Carrol, Philip Pallmann, Jonathan A.T. Sandoe

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2 Citations (Scopus)

Abstract

BACKGROUND: Blood biomarkers have the potential to help identify COVID-19 patients with bacterial coinfection in whom antibiotics are indicated. During the COVID-19 pandemic, procalcitonin testing was widely introduced at hospitals in the UK to guide antibiotic prescribing. We have determined the impact of this on hospital-level antibiotic consumption. 

METHODS: We conducted a retrospective, controlled interrupted time series analysis of organization-level data describing antibiotic dispensing, hospital activity and procalcitonin testing for acute hospitals/hospital trusts in England and Wales during the first wave of COVID-19 (24 February to 5 July 2020). 

RESULTS: In the main analysis of 105 hospitals in England, introduction of procalcitonin testing in emergency departments/acute medical admission units was associated with a statistically significant decrease in total antibiotic use of -1.08 (95% CI: -1.81 to -0.36) DDDs of antibiotic per admission per week per trust. This effect was then lost at a rate of 0.05 (95% CI: 0.02-0.08) DDDs per admission per week. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions rather than all admissions. Introduction of procalcitonin in the ICU setting was not associated with any significant change in antibiotic use. 

CONCLUSIONS: At hospitals where procalcitonin testing was introduced in emergency departments/acute medical units this was associated with an initial, but unsustained, reduction in antibiotic use. Further research should establish the patient-level impact of procalcitonin testing in this population and understand its potential for clinical effectiveness.

Original languageEnglish
Pages (from-to)1189-1196
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume77
Issue number4
Early online date8 Feb 2022
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information: No funding information.

Open Access: No Open Access licence.

Publisher Copyright:© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved.

Citation: Martin J. Llewelyn, Detelina Grozeva, Philip Howard, Joanne Euden, Sarah M. Gerver, Russell Hope, Margaret Heginbothom, Neil Powell, Colin Richman, Dominick Shaw, Emma Thomas-Jones, Robert M. West, Enitan D. Carrol, Philip Pallmann, Jonathan A. T. Sandoe, on behalf of the PEACH study team, Impact of introducing procalcitonin testing on antibiotic usage in acute NHS hospitals during the first wave of COVID-19 in the UK: a controlled interrupted time series analysis of organization-level data, Journal of Antimicrobial Chemotherapy, Volume 77, Issue 4, April 2022, Pages 1189–1196.

DOI:: https://doi.org/10.1093/jac/dkac017

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