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

21 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

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

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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), Article 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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year = "2021",

month = may,

doi = "10.3390/antibiotics10050516",

language = "English",

volume = "10",

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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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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.

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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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U2 - 10.3390/antibiotics10050516

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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