The Role of Procalcitonin in Antibiotic Decision-Making in Covid-19 Infection

Valeria Fabre, Sara Karaba, Joe Amoah, Matthew Robinson, George Jones, Kathryn Dzintars, Morgan Katz, B Mark Landrum, Sarojini Qasba, Pooja Gupta, Eili Klein, Sara E Cosgrove
Infection Control and Hospital Epidemiology 2021 April 19, : 1-24

OBJECTIVE: To evaluate the role of procalcitonin (PCT) in antibiotic decisions for COVID-19 patients at hospital presentation.

DESIGN, SETTING AND PARTICIPANTS: Multicenter retrospective observational study of patients 18 years hospitalized due to COVID-19 at the Johns Hopkins Health system. Patients who were transferred from another facility with >24 hours stay and patients who died within 48 hours of hospitalization were excluded.

METHODS: Elevated PCT values were determined based on each hospitals definition. Antibiotic therapy and PCT results were evaluated for patients with no evidence of bacterial community-acquired pneumonia (bCAP) and patients with confirmed, probable, or possible bCAP. The added value of PCT to clinical criteria in detecting bCAP were evaluated with receiving operating curve characteristics (ROC).

RESULTS: 64% (611/962) of patients received a PCT. ROC curves for clinical criteria and clinical criteria plus PCT were similar (at 0.5ng/ml and 0.25ng/ml). By bCAP group, median initial PCT values were 0.58 ng/mL (IQR 0.24, 1.14), 0.23 ng/mL (IQR 0.1, 0.63) and 0.15 ng/mL (IQR 0.09, 0.35) for proven/probable, possible, and no bCAP groups. Among patients without bCAP, an elevatedPCT was associated with 1.8 additional days of CAP therapy (95% CI 1.01 2.75, P<0.01) compared to patients with a negative PCT after adjusting for potential confounders. Duration of CAP therapy was similar between patients without a PCT ordered and a low PCT for no bCAP and possible bCAP groups.

CONCLUSIONS: PCT may be abnormal in COVID-19 patients without bCAP and may result in receipt of unnecessary antibiotics.

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