Use of procalcitonin during the first wave of covid-19 in the acute nhs hospitals: A retrospective observational study

Neil Powell; Philip Howard; Martin J. Llewelyn; Tamas Szakmany; Mahableswhar Albur; Stuart E. Bond; Joanne Euden; Lucy Brookes-Howell; Paul Dark; Thomas P. Hellyer; Susan Hopkins; Iain J. McCullagh; Margaret Ogden; Philip Pallmann; Helena Parsons; David G. Partridge; Dominick E. Shaw; Bethany Shinkins; Stacy Todd; Emma Thomas-Jones; Robert West; Enitan D. Carrol; Jonathan A.T. Sandoe

doi:10.3390/antibiotics10050516

Use of procalcitonin during the first wave of covid-19 in the acute nhs hospitals: A retrospective observational study

Neil Powell^*, Philip Howard, Martin J. Llewelyn, Tamas Szakmany, Mahableswhar Albur, Stuart E. Bond, Joanne Euden, Lucy Brookes-Howell, Paul Dark, Thomas P. Hellyer, Susan Hopkins, Iain J. McCullagh, Margaret Ogden, Philip Pallmann, Helena Parsons, David G. Partridge, Dominick E. Shaw, Bethany Shinkins, Stacy Todd, Emma Thomas-JonesRobert West, Enitan D. Carrol, Jonathan A.T. Sandoe

^*Corresponding author for this work

HCAI and AMR Divisional Office

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

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.

Original language	English
Article number	516
Number of pages	8
Journal	Antibiotics
Volume	10
Issue number	5
DOIs	https://doi.org/10.3390/antibiotics10050516
Publication status	Published - May 2021

Bibliographical note

Funding Information:
This research was funded by the National Institute for Health Research (NIHR) COVID Learning & Recovery call (NIHR132254). The views expressed are those of the author and not necessarily those of the NIHR or Department of Health and Social Care. Conflicts of Interest: J.A.T.S. has current research funding relating to diagnostic testing from NIHR, MRC, EPSRC, Wellcome Trust, and Leeds Cares. Within the last 5 years, J.S. has been involved in research funded by Pfizer, Astellas, and Merck Sharp and Dohme. N.P. has received honoraria from Thermofisher. P.D. is ADAPT sepsis Chief Investigator. M.J.L., J.E., P.H., S.T. are investigators on PRONTO. M.A. has received lecturing fees from Pfizer, and lecturing fees from Shionogi, H.D.R. U.K. P.P. E.C. E.T.J. investigators on PRONTO, BATCH, PRECISE. T.H. I.M., investigators on ADAPT (RISC-sepsis) B.S. supported by the NIHR In Vitro diagnostics Co-operative. T.S., D.P., S.B., M.O., H.P., D.S., R.W., L.B.H., S.H. none to declare.

Funding Information:
The Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH) study [16] has been commissioned and funded by the National Institute of Health Research (NIHR) to evaluate whether the use of PCT testing to guide antibiotic prescribing safely reduced antibiotic use among patients admitted to acute UK NHS hospitals with COVID-19. Here, we describe how acute NHS hospitals used PCT testing to guide antibiotic prescribing during the first wave of the COVID-19 pandemic in England and Wales.

Funding Information:
Funding: This research was funded by the National Institute for Health Research (NIHR) COVID Learning & Recovery call (NIHR132254). The views expressed are those of the author and not necessarily those of the NIHR or Department of Health and Social Care.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

Antibiotic
COVID-19
Procalcitonin
Stewardship

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3390/antibiotics10050516

Cite this

Powell, N., Howard, P., Llewelyn, M. J., Szakmany, T., Albur, M., Bond, S. E., Euden, J., Brookes-Howell, L., Dark, P., Hellyer, T. P., Hopkins, S., McCullagh, I. J., Ogden, M., Pallmann, P., Parsons, H., Partridge, D. G., Shaw, D. E., Shinkins, B., Todd, S., ... Sandoe, J. A. T. (2021). Use of procalcitonin during the first wave of covid-19 in the acute nhs hospitals: A retrospective observational study. Antibiotics, 10(5), [516]. https://doi.org/10.3390/antibiotics10050516

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title = "Use of procalcitonin during the first wave of covid-19 in the acute nhs hospitals: A retrospective observational study",

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.",

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author = "Neil Powell and Philip Howard and Llewelyn, {Martin J.} and Tamas Szakmany and Mahableswhar Albur and Bond, {Stuart E.} and Joanne Euden and Lucy Brookes-Howell and Paul Dark and Hellyer, {Thomas P.} and Susan Hopkins and McCullagh, {Iain J.} and Margaret Ogden and Philip Pallmann and Helena Parsons and Partridge, {David G.} and Shaw, {Dominick E.} and Bethany Shinkins and Stacy Todd and Emma Thomas-Jones and Robert West and Carrol, {Enitan D.} and Sandoe, {Jonathan A.T.}",

note = "Funding Information: This research was funded by the National Institute for Health Research (NIHR) COVID Learning & Recovery call (NIHR132254). The views expressed are those of the author and not necessarily those of the NIHR or Department of Health and Social Care. Conflicts of Interest: J.A.T.S. has current research funding relating to diagnostic testing from NIHR, MRC, EPSRC, Wellcome Trust, and Leeds Cares. Within the last 5 years, J.S. has been involved in research funded by Pfizer, Astellas, and Merck Sharp and Dohme. N.P. has received honoraria from Thermofisher. P.D. is ADAPT sepsis Chief Investigator. M.J.L., J.E., P.H., S.T. are investigators on PRONTO. M.A. has received lecturing fees from Pfizer, and lecturing fees from Shionogi, H.D.R. U.K. P.P. E.C. E.T.J. investigators on PRONTO, BATCH, PRECISE. T.H. I.M., investigators on ADAPT (RISC-sepsis) B.S. supported by the NIHR In Vitro diagnostics Co-operative. T.S., D.P., S.B., M.O., H.P., D.S., R.W., L.B.H., S.H. none to declare. Funding Information: The Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH) study [16] has been commissioned and funded by the National Institute of Health Research (NIHR) to evaluate whether the use of PCT testing to guide antibiotic prescribing safely reduced antibiotic use among patients admitted to acute UK NHS hospitals with COVID-19. Here, we describe how acute NHS hospitals used PCT testing to guide antibiotic prescribing during the first wave of the COVID-19 pandemic in England and Wales. Funding Information: Funding: This research was funded by the National Institute for Health Research (NIHR) COVID Learning & Recovery call (NIHR132254). The views expressed are those of the author and not necessarily those of the NIHR or Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2021 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2021",

month = may,

doi = "10.3390/antibiotics10050516",

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volume = "10",

journal = "Antibiotics",

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Powell, N, Howard, P, Llewelyn, MJ, Szakmany, T, Albur, M, Bond, SE, Euden, J, Brookes-Howell, L, Dark, P, Hellyer, TP, Hopkins, S, McCullagh, IJ, Ogden, M, Pallmann, P, Parsons, H, Partridge, DG, Shaw, DE, Shinkins, B, Todd, S, Thomas-Jones, E, West, R, Carrol, ED & Sandoe, JAT 2021, 'Use of procalcitonin during the first wave of covid-19 in the acute nhs hospitals: A retrospective observational study', Antibiotics, vol. 10, no. 5, 516. https://doi.org/10.3390/antibiotics10050516

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T1 - Use of procalcitonin during the first wave of covid-19 in the acute nhs hospitals

T2 - A retrospective observational study

AU - Powell, Neil

AU - Howard, Philip

AU - Llewelyn, Martin J.

AU - Szakmany, Tamas

AU - Albur, Mahableswhar

AU - Bond, Stuart E.

AU - Euden, Joanne

AU - Brookes-Howell, Lucy

AU - Dark, Paul

AU - Hellyer, Thomas P.

AU - Hopkins, Susan

AU - McCullagh, Iain J.

AU - Ogden, Margaret

AU - Pallmann, Philip

AU - Parsons, Helena

AU - Partridge, David G.

AU - Shaw, Dominick E.

AU - Shinkins, Bethany

AU - Todd, Stacy

AU - Thomas-Jones, Emma

AU - West, Robert

AU - Carrol, Enitan D.

AU - Sandoe, Jonathan A.T.

N1 - Funding Information: This research was funded by the National Institute for Health Research (NIHR) COVID Learning & Recovery call (NIHR132254). The views expressed are those of the author and not necessarily those of the NIHR or Department of Health and Social Care. Conflicts of Interest: J.A.T.S. has current research funding relating to diagnostic testing from NIHR, MRC, EPSRC, Wellcome Trust, and Leeds Cares. Within the last 5 years, J.S. has been involved in research funded by Pfizer, Astellas, and Merck Sharp and Dohme. N.P. has received honoraria from Thermofisher. P.D. is ADAPT sepsis Chief Investigator. M.J.L., J.E., P.H., S.T. are investigators on PRONTO. M.A. has received lecturing fees from Pfizer, and lecturing fees from Shionogi, H.D.R. U.K. P.P. E.C. E.T.J. investigators on PRONTO, BATCH, PRECISE. T.H. I.M., investigators on ADAPT (RISC-sepsis) B.S. supported by the NIHR In Vitro diagnostics Co-operative. T.S., D.P., S.B., M.O., H.P., D.S., R.W., L.B.H., S.H. none to declare. Funding Information: The Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH) study [16] has been commissioned and funded by the National Institute of Health Research (NIHR) to evaluate whether the use of PCT testing to guide antibiotic prescribing safely reduced antibiotic use among patients admitted to acute UK NHS hospitals with COVID-19. Here, we describe how acute NHS hospitals used PCT testing to guide antibiotic prescribing during the first wave of the COVID-19 pandemic in England and Wales. Funding Information: Funding: This research was funded by the National Institute for Health Research (NIHR) COVID Learning & Recovery call (NIHR132254). The views expressed are those of the author and not necessarily those of the NIHR or Department of Health and Social Care. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

PY - 2021/5

Y1 - 2021/5

N2 - 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.

AB - 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.

KW - Antibiotic

KW - COVID-19

KW - Procalcitonin

KW - Stewardship

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DO - 10.3390/antibiotics10050516

M3 - Article

AN - SCOPUS:85105930282

SN - 2079-6382

VL - 10

JO - Antibiotics

JF - Antibiotics

IS - 5

M1 - 516

ER -

Use of procalcitonin during the first wave of covid-19 in the acute nhs hospitals: A retrospective observational study

Abstract

Bibliographical note

Keywords

UN SDGs

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