Procalcitonin-guided antibiotic prescription in patients with COVID-19: a multicentre observational cohort study.

BACKGROUND: Despite the low rate of bacterial co-infection, antibiotics are very commonly prescribed in hospitalised COVID-19 patients.

RESEARCH QUESTION: Does the use of a PCT-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection?

STUDY DESIGN AND METHODS: In this multicentre cohort, 3 groups of COVID-19 patients were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n=216) and 2 control groups, consisted of patients from the same hospital (n=57) and of patients from 3 similar hospitals (n=486) without PCT measurements during the same period. The primary endpoint was antibiotic prescription in the first week of admission.

RESULTS: Antibiotic prescription during the first 7 days was 26.8% in the PCT-group, 43.9% in the non-PCT group in the same hospital and 44.7% in the non-PCT group in other hospitals. Patients in the PCT-group had lower odds of receiving antibiotics in the first 7 days of admission (OR 0.33; 0.16 - 0.66 compared to the same hospital and OR 0.42; 95% CI 0.28 - 0.62 compared to the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was respectively 35.2%, 43.9% and 54.5%. The PCT-group had lower odds of receiving antibiotics during the total admission only when compared to the other hospitals (OR 0.23; 95%CI 0.08 - 0.63). There were no significant differences in other secondary endpoints, except for re-admission in the PCT-group versus the other hospitals group.

INTERPRETATION: PCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalised patients with COVID-19, without major safety concerns.