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Scavello F, Brunetta E, Mapelli SN, Nappi E, García Martín ID, Sironi M, Leone R, Solano S, Angelotti G, Supino D, Carnevale S, Zhong H, Magrini E, Stravalaci M, Protti A, Santini A, Costantini E, Savevski V, Voza A, Bottazzi B, Bartoletti M, Cecconi M, Mantovani A, Morelli P, Tordato F, Garlanda C. The long Pentraxin PTX3 serves as an early predictive biomarker of co-infections in COVID-19. EBioMedicine 2024; 105:105213. [PMID: 38908098 DOI: 10.1016/j.ebiom.2024.105213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND COVID-19 clinical course is highly variable and secondary infections contribute to COVID-19 complexity. Early detection of secondary infections is clinically relevant for patient outcome. Procalcitonin (PCT) and C-reactive protein (CRP) are the most used biomarkers of infections. Pentraxin 3 (PTX3) is an acute phase protein with promising performance as early biomarker in infections. In patients with COVID-19, PTX3 plasma concentrations at hospital admission are independent predictor of poor outcome. In this study, we assessed whether PTX3 contributes to early identification of co-infections during the course of COVID-19. METHODS We analyzed PTX3 levels in patients affected by COVID-19 with (n = 101) or without (n = 179) community or hospital-acquired fungal or bacterial secondary infections (CAIs or HAIs). FINDINGS PTX3 plasma concentrations at diagnosis of CAI or HAI were significantly higher than those in patients without secondary infections. Compared to PCT and CRP, the increase of PTX3 plasma levels was associated with the highest hazard ratio for CAIs and HAIs (aHR 11.68 and 24.90). In multivariable Cox regression analysis, PTX3 was also the most significant predictor of 28-days mortality or intensive care unit admission of patients with potential co-infections, faring more pronounced than CRP and PCT. INTERPRETATION PTX3 is a promising predictive biomarker for early identification and risk stratification of patients with COVID-19 and co-infections. FUNDING Dolce & Gabbana fashion house donation; Ministero della Salute for COVID-19; EU funding within the MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases (Project no. PE00000007, INF-ACT) and MUR PNRR Italian network of excellence for advanced diagnosis (Project no. PNC-E3-2022-23683266 PNC-HLS-DA); EU MSCA (project CORVOS 860044).
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Affiliation(s)
| | - Enrico Brunetta
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Sarah N Mapelli
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Emanuele Nappi
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Ian David García Martín
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Marina Sironi
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Roberto Leone
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Simone Solano
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Giovanni Angelotti
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Domenico Supino
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Hang Zhong
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Elena Magrini
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Alessandro Protti
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Alessandro Santini
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Victor Savevski
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Emergency Department, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Michele Bartoletti
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Paola Morelli
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Cecilia Garlanda
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.
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Lukose L, Kaur G, M MA, Abraham GA, Khera K, Subeesh VK, Castelino RL, Karanth S, Udyavara Kudru C, Varma M, Miraj SS. Predictors and patterns of empirical antibiotic therapy and associated outcomes in COVID-19 patients: a retrospective study in a tertiary care facility in South India. Expert Rev Anti Infect Ther 2024; 22:333-341. [PMID: 38189087 DOI: 10.1080/14787210.2024.2303019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The coronavirus disease (COVID-19) led to a global health crisis. Inappropriate use of antibiotics in COVID-19 patients has been a concern, leading to antimicrobial resistance. This study evaluated the patterns and predictors of empirical antibiotic therapy in COVID-19 patients and associated outcomes. METHODS A hospital-based retrospective study was conducted with 525 patients admitted to Kasturba Hospital, Manipal, India, with moderate and severe COVID-19 from 1 March to 1 August 2021. They were divided based on empirical therapy, and predictors of antibiotic usage were assessed by logistic regression. RESULTS Four hundred and eighty (91.4%) COVID-19 patients received at least one course of antibiotics, with 440 (83.8%) initiating empirical therapy. Patients with severe COVID-19 manifestations were more likely to be prescribed empirical antibiotics. Multivariable analysis showed that patients initiated on empirical antibiotics had significantly elevated levels of procalcitonin [OR: 3.91 (95% CI: 1.66-9.16) (p = 0.001)], invasive ventilation [OR: 3.93 (95% CI: 1.70-9.09) (p = 0.001)], shortness of breath [OR: 2.25 (95% CI: 1.30-3.89) (p = 0.003)] and higher CRP levels [OR: 1.01 (95% CI: 1.00-1.01) (p = 0.005)]. Most antibiotics (65.9%) were prescribed from the 'Watch' group, the highest being ceftriaxone. Only 23.8% of the patients had microbiologically confirmed infections. CONCLUSION The study identified predictors for initiating empirical antibacterial therapy in our setting.
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Affiliation(s)
- Lipin Lukose
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Gursimran Kaur
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Mohammed Asif M
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Gail Ann Abraham
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Kanav Khera
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
- Department of Pharmacy Practice, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Viswam K Subeesh
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Ronald L Castelino
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Shubhada Karanth
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sonal Sekhar Miraj
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
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Doubravská L, Htoutou Sedláková M, Fišerová K, Klementová O, Turek R, Langová K, Kolář M. Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19-A Prospective Monocentric Cohort Study. Antibiotics (Basel) 2024; 13:192. [PMID: 38391578 PMCID: PMC10886267 DOI: 10.3390/antibiotics13020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).
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Affiliation(s)
- Lenka Doubravská
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Miroslava Htoutou Sedláková
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Fišerová
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Olga Klementová
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Radovan Turek
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Langová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Milan Kolář
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
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Lui GC, Cheung CS, Yip TC, Lai MS, Li TC, Wong GL. Bacterial infections in patients with COVID-19: the impact of procalcitonin testing on antibiotics prescription in the real world. BMC Infect Dis 2024; 24:106. [PMID: 38243171 PMCID: PMC10797859 DOI: 10.1186/s12879-023-08849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/25/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Bacterial infections are not prevalent among patients hospitalized with COVID-19, while unnecessary prescription of antibiotics was commonly observed. This study aimed to determine the impact of procalcitonin testing on antibiotics prescription in the real-world setting. METHODS We performed a territory-wide retrospective cohort study involving all laboratory-confirmed patients hospitalized in public hospitals in Hong Kong in 2020 with COVID-19. We determined the prevalence of bacterial co-infections (documented infections within 72 h of admission) and secondary bacterial infections (infections after 72 h of admission) and antibiotics consumption, and the correlation between procalcitonin testing and antibiotics prescription. RESULTS The cohort included 8666 patients, with mean age 45.3 ± 19.9 years, 48.5% male, and comorbidities in 26.9%. Among 2688 patients with bacterial cultures performed, 147 (5.5%) had bacterial co-infections, and 222 (8.3%) had secondary bacterial infections. Antibiotics were prescribed for 2773 (32.0%) patients during the hospital admission. Procalcitonin tests were performed for 2543 (29.3%) patients. More patients with procalcitonin testing received antibiotics (65.9% vs. 17.9%, p < 0.001). Procalcitonin testing was associated with 5-fold increased risk of antibiotics prescription after adjusting for confounding variables. At hospital level, procalcitonin testing correlated with antibiotics prescription. Patients with procalcitonin level < 0.5 ng/mL had a lower probability of antibiotics initiation and shorter duration of antibiotics therapy. CONCLUSIONS Procalcitonin testing was not associated with lower prescription of antibiotics. Patients with low procalcitonin level had lower antibiotics exposure, supporting the use of procalcitonin to exclude bacterial infections aiding early stopping of antibiotics among patients hospitalized with COVID-19.
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Affiliation(s)
- Grace Cy Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Hong Kong SAR, China
| | - Catherine Sk Cheung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Hong Kong SAR, China
| | - Terry Cf Yip
- Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mandy Sm Lai
- Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Cm Li
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Hong Kong SAR, China
| | - Grace Lh Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 9/F Lui Che Woo Clinical Sciences Building, Hong Kong SAR, China.
- Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China.
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Van Laethem J, Pierreux J, Wuyts SC, De Geyter D, Allard SD, Dauby N. Using risk factors and markers to predict bacterial respiratory co-/superinfections in COVID-19 patients: is the antibiotic steward's toolbox full or empty? Acta Clin Belg 2023; 78:418-430. [PMID: 36724448 DOI: 10.1080/17843286.2023.2167328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/07/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adequate diagnosis of bacterial respiratory tract co-/superinfection (bRTI) in coronavirus disease (COVID-19) patients is challenging, as there is insufficient knowledge about the role of risk factors and (para)clinical parameters in the identification of bacterial co-/superinfection in the COVID-19 setting. Empirical antibiotic therapy is mainly based on COVID-19 severity and expert opinion, rather than on scientific evidence generated since the start of the pandemic. PURPOSE We report the best available evidence regarding the predictive value of risk factors and (para)clinical markers in the diagnosis of bRTI in COVID-19 patients. METHODS A multidisciplinary team identified different potential risk factors and (para)clinical predictors of bRTI in COVID-19 and formulated one or two research questions per topic. After a thorough literature search, research gaps were identified, and suggestions concerning further research were formulated. The quality of this narrative review was ensured by following the Scale for the Assessment of Narrative Review Articles. RESULTS Taking into account the scarcity of scientific evidence for markers and risk factors of bRTI in COVID-19 patients, to date, COVID-19 severity is the only parameter which can be associated with higher risk of developing bRTI. CONCLUSIONS Evidence on the usefulness of risk factors and (para)clinical factors as predictors of bRTI in COVID-19 patients is scarce. Robust studies are needed to optimise antibiotic prescribing and stewardship activities in the context of COVID-19.
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Affiliation(s)
- Johan Van Laethem
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Pierreux
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Stephanie Cm Wuyts
- Universitair Ziekenhuis Brussel (UZ Brussel), Hospital Pharmacy, Brussels, Belgium
- Research group Clinical Pharmacology and Pharmacotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Deborah De Geyter
- Microbiology and Infection Control Department, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Sabine D Allard
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Nicolas Dauby
- Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Infectious Diseases, CHU Saint-Pierre - Université Libre de Bruxelles (ULB), Brussels, Belgium
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6
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Ceccarelli G, Alessandri F, Migliara G, Baccolini V, Giordano G, Galardo G, Marzuillo C, De Vito C, Russo A, Ciccozzi M, Villari P, Venditti M, Mastroianni CM, Pugliese F, d’Ettorre G. Reduced Reliability of Procalcitonin (PCT) as a Biomarker of Bacterial Superinfection: Concerns about PCT-Driven Antibiotic Stewardship in Critically Ill COVID-19 Patients-Results from a Retrospective Observational Study in Intensive Care Units. J Clin Med 2023; 12:6171. [PMID: 37834815 PMCID: PMC10573961 DOI: 10.3390/jcm12196171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients. METHODS In this retrospective, observational study, all critically ill COVID-19 patients who survived for ≥2 days in a single university hospital and had at least one serum procalcitonin (PCT) value and associated blood culture and/or culture from a lower respiratory tract specimen available were eligible for the study. RESULTS Over the research period, 184 patients were recruited; 67 VAP/BSI occurred, with an incidence rate of 21.82 episodes of VAP/BSI (95% CI: 17.18-27.73) per 1000 patient-days among patients who were included. At the time of a positive microbiological culture, an average PCT level of 1.25-3.2 ng/mL was found. Moreover, also in subjects without positive cultures, PCT was altered in 21.7% of determinations, with an average value of 1.04-5.5 ng/mL. Both PCT and PCT-72 h were not linked to a diagnosis of VAP/BSI in COVID-19 patients, according to the multivariable GEE models (aOR 1.13, 95% CI 0.51-2.52 for PCT; aOR 1.32, 95% CI 0.66-2.64 for PCT-72 h). CONCLUSION Elevated PCT levels might not always indicate bacterial superinfections or coinfections in a severe COVID-19 setting.
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Affiliation(s)
- Giancarlo Ceccarelli
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Francesco Alessandri
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
- Intensive Care Unit, Department of General, Specialistic Surgery, University of Rome Sapienza, 00185 Rome, Italy
| | - Giuseppe Migliara
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Valentina Baccolini
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Giovanni Giordano
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
- Intensive Care Unit, Department of General, Specialistic Surgery, University of Rome Sapienza, 00185 Rome, Italy
| | - Gioacchino Galardo
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Alessandro Russo
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy;
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Mario Venditti
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Claudio M. Mastroianni
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
| | - Francesco Pugliese
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
- Intensive Care Unit, Department of General, Specialistic Surgery, University of Rome Sapienza, 00185 Rome, Italy
| | - Gabriella d’Ettorre
- Hospital Policlinico Umberto I, 00161 Rome, Italy; (G.C.); (G.G.); (G.M.); (V.B.); (G.G.); (M.V.); (C.M.M.); (F.P.); (G.d.)
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, 00185 Rome, Italy; (C.M.); (P.V.)
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Wei S, Wang L, Lin L, Liu X. Predictive values of procalcitonin for coinfections in patients with COVID-19: a systematic review and meta-analysis. Virol J 2023; 20:92. [PMID: 37158904 PMCID: PMC10166029 DOI: 10.1186/s12985-023-02042-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To assess the ability of procalcitonin (PCT)-a promising marker for coinfections-to predict coinfections in patients with COVID-19. METHODS In this systematic review and meta-analysis, PubMed, Embase, Web of Science, Cochrane, the China National Knowledge Infrastructure (CNKI), and Wanfang were searched to identify eligible studies (up to August 30, 2021). Articles that reported the predictive value of PCT for coinfections in patients with COVID-19 were included. Individual and pooled sensitivities and specificities were reported, and I2 was used to test heterogeneity. This study was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number: CRD42021283344). RESULTS Five studies involving a total of 2775 patients reported the predictive value of PCT for coinfections in patients with COVID-19. The sensitivity, specificity, and area under the curve of PCT in predicting coinfections in the pooled studies were 0.60 (95% CI 0.35-0.81, I2 = 88.85), 0.71 (95% CI 0.58-0.81, I2 = 87.82), and 0.72(95% CI 0.68-0.76) respectively. CONCLUSIONS Although PCT has limited predictive value for coinfections in patients with COVID-19, lower PCT levels seem to indicate a decreased probability of having a coinfection.
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Affiliation(s)
- Shanchen Wei
- Department of Geriatrics, Peking University First Hospital, Xishiku Avenue No 8, Xicheng District, Beijing, 100034, China
| | - Lina Wang
- Department of Geriatrics, Peking University First Hospital, Xishiku Avenue No 8, Xicheng District, Beijing, 100034, China
| | - Lianjun Lin
- Department of Geriatrics, Peking University First Hospital, Xishiku Avenue No 8, Xicheng District, Beijing, 100034, China.
| | - Xinmin Liu
- Department of Geriatrics, Peking University First Hospital, Xishiku Avenue No 8, Xicheng District, Beijing, 100034, China.
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8
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Recommendations and guidelines for the diagnosis and management of Coronavirus Disease-19 (COVID-19) associated bacterial and fungal infections in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:207-235. [PMID: 36586743 PMCID: PMC9767873 DOI: 10.1016/j.jmii.2022.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Coronavirus disease-19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 that has rapidly evolved into a pandemic to cause over 600 million infections and more than 6.6 million deaths up to Nov 25, 2022. COVID-19 carries a high mortality rate in severe cases. Co-infections and secondary infections with other micro-organisms, such as bacterial and fungus, further increases the mortality and complicates the diagnosis and management of COVID-19. The current guideline provides guidance to physicians for the management and treatment of patients with COVID-19 associated bacterial and fungal infections, including COVID-19 associated bacterial infections (CABI), pulmonary aspergillosis (CAPA), candidiasis (CAC) and mucormycosis (CAM). Recommendations were drafted by the 7th Guidelines Recommendations for Evidence-based Antimicrobial agents use Taiwan (GREAT) working group after review of the current evidence, using the grading of recommendations assessment, development, and evaluation (GRADE) methodology. A nationwide expert panel reviewed the recommendations in March 2022, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes the epidemiology, diagnostic methods and treatment recommendations for COVID-19 associated infections. The aim of this guideline is to provide guidance to physicians who are involved in the medical care for patients with COVID-19 during the ongoing COVID-19 pandemic.
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9
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Moisa E, Dutu M, Corneci D, Grintescu IM, Negoita S. Hematological Parameters and Procalcitonin as Discriminants between Bacterial Pneumonia-Induced Sepsis and Viral Sepsis Secondary to COVID-19: A Retrospective Single-Center Analysis. Int J Mol Sci 2023; 24:ijms24065146. [PMID: 36982221 PMCID: PMC10049727 DOI: 10.3390/ijms24065146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Bacterial and viral sepsis induce alterations of all hematological parameters and procalcitonin is used as a biomarker of infection and disease severity. Our aim was to study the hematological patterns associated with pulmonary sepsis triggered by bacteria and Severe Acute Respiratory Syndrome-Coronavirus-type-2 (SARS-CoV-2) and to identify the discriminants between them. We performed a retrospective, observational study including 124 patients with bacterial sepsis and 138 patients with viral sepsis. Discriminative ability of hematological parameters and procalcitonin between sepsis types was tested using receiver operating characteristic (ROC) analysis. Sensitivity (Sn%), specificity (Sp%), positive and negative likelihood ratios were calculated for the identified cut-off values. Patients with bacterial sepsis were older than patients with viral sepsis (p < 0.001), with no differences regarding gender. Subsequently to ROC analysis, procalcitonin had excellent discriminative ability for bacterial sepsis diagnosis with an area under the curve (AUC) of 0.92 (cut-off value of >1.49 ng/mL; Sn = 76.6%, Sp = 94.2%), followed by RDW% with an AUC = 0.87 (cut-off value >14.8%; Sn = 80.7%, Sp = 85.5%). Leukocytes, monocytes and neutrophils had good discriminative ability with AUCs between 0.76-0.78 (p < 0.001), while other hematological parameters had fair or no discriminative ability. Lastly, procalcitonin value was strongly correlated with disease severity in both types of sepsis (p < 0.001). Procalcitonin and RDW% had the best discriminative ability between bacterial and viral sepsis, followed by leukocytes, monocytes and neutrophils. Procalcitonin is a marker of disease severity regardless of sepsis type.
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Affiliation(s)
- Emanuel Moisa
- Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Clinic of Anaesthesia and Intensive Care Medicine, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Madalina Dutu
- Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Clinic of Anaesthesia and Intensive Care Medicine, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Dan Corneci
- Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Clinic of Anaesthesia and Intensive Care Medicine, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Ioana Marina Grintescu
- Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Clinic of Anaesthesia and Intensive Care Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Silvius Negoita
- Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Clinic of Anaesthesia and Intensive Care Medicine, Elias University Emergency Hospital, 011461 Bucharest, Romania
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10
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Langford BJ, So M, Simeonova M, Leung V, Lo J, Kan T, Raybardhan S, Sapin ME, Mponponsuo K, Farrell A, Leung E, Soucy JPR, Cassini A, MacFadden D, Daneman N, Bertagnolio S. Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis. THE LANCET. MICROBE 2023; 4:e179-e191. [PMID: 36736332 PMCID: PMC9889096 DOI: 10.1016/s2666-5247(22)00355-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/08/2022] [Accepted: 11/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Frequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed to establish the prevalence and predictors of bacterial infections and antimicrobial resistance in patients with COVID-19. METHODS We did a systematic review and meta-analysis of studies of bacterial co-infections (identified within ≤48 h of presentation) and secondary infections (>48 h after presentation) in outpatients or hospitalised patients with COVID-19. We searched the WHO COVID-19 Research Database to identify cohort studies, case series, case-control trials, and randomised controlled trials with populations of at least 50 patients published in any language between Jan 1, 2019, and Dec 1, 2021. Reviews, editorials, letters, pre-prints, and conference proceedings were excluded, as were studies in which bacterial infection was not microbiologically confirmed (or confirmed via nasopharyngeal swab only). We screened titles and abstracts of papers identified by our search, and then assessed the full text of potentially relevant articles. We reported the pooled prevalence of bacterial infections and antimicrobial resistance by doing a random-effects meta-analysis and meta-regression. Our primary outcomes were the prevalence of bacterial co-infection and secondary infection, and the prevalence of antibiotic-resistant pathogens among patients with laboratory-confirmed COVID-19 and bacterial infections. The study protocol was registered with PROSPERO (CRD42021297344). FINDINGS We included 148 studies of 362 976 patients, which were done between December, 2019, and May, 2021. The prevalence of bacterial co-infection was 5·3% (95% CI 3·8-7·4), whereas the prevalence of secondary bacterial infection was 18·4% (14·0-23·7). 42 (28%) studies included comprehensive data for the prevalence of antimicrobial resistance among bacterial infections. Among people with bacterial infections, the proportion of infections that were resistant to antimicrobials was 60·8% (95% CI 38·6-79·3), and the proportion of isolates that were resistant was 37·5% (26·9-49·5). Heterogeneity in the reported prevalence of antimicrobial resistance in organisms was substantial (I2=95%). INTERPRETATION Although infrequently assessed, antimicrobial resistance is highly prevalent in patients with COVID-19 and bacterial infections. Future research and surveillance assessing the effect of COVID-19 on antimicrobial resistance at the patient and population level are urgently needed. FUNDING WHO.
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Affiliation(s)
- Bradley J Langford
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Miranda So
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
| | | | - Valerie Leung
- Public Health Ontario, Toronto, ON, Canada; Toronto East Health Network, Toronto, ON, Canada
| | - Jennifer Lo
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tiffany Kan
- North York General Hospital, Toronto, ON, Canada
| | | | - Mia E Sapin
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Mponponsuo
- University of Calgary, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada
| | | | - Elizabeth Leung
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, UK
| | - Jean-Paul R Soucy
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Derek MacFadden
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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11
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Cohen AJ, Glick LR, Lee S, Kunitomo Y, Tsang DA, Pitafi S, Valda Toro P, Ristic NR, Zhang E, Carey GB, Datta R, Dela Cruz CS, Gautam S. Nonutility of procalcitonin for diagnosing bacterial pneumonia in patients with severe COVID-19. Eur Clin Respir J 2023; 10:2174640. [PMID: 36815942 PMCID: PMC9930745 DOI: 10.1080/20018525.2023.2174640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
Background Patients hospitalized with COVID-19 are at significant risk for superimposed bacterial pneumonia. However, diagnosing superinfection is challenging due to its clinical resemblance to severe COVID-19. We therefore evaluated whether the immune biomarker, procalcitonin, could facilitate the diagnosis of bacterial superinfection. Methods We retrospectively identified 185 patients hospitalized with severe COVID-19 who underwent lower respiratory culture; 85 had evidence of bacterial superinfection. Receiver operating characteristic curve and area under the curve (AUC) analyses were performed to assess the utility of procalcitonin for diagnosing superinfection. Results This approach demonstrated that procalcitonin measured at the time of culture was incapable of distinguishing patients with bacterial infection (AUC, 0.52). The AUC not affected by exposure to antibiotics, treatment with immunomodulatory agents, or timing of procalcitonin measurement. Conclusion Static measurement of procalcitonin does not aid in the diagnosis of superinfection in severe COVID-19.
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Affiliation(s)
- Avi J. Cohen
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Laura R. Glick
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Seohyuk Lee
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yukiko Kunitomo
- Johns Hopkins Hospital, Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Derek A. Tsang
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Pitafi
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Patricia Valda Toro
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas R. Ristic
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Ethan Zhang
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - George B. Carey
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Rupak Datta
- Veterans Affairs Connecticut Healthcare System, Hospital Epidemiology and Infection Prevention Program, West Haven, CT, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Charles S. Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
- Section of Pulmonary, Critical Care, and Sleep Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, CT, USA
| | - Samir Gautam
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
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12
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Gao CA, Pickens CI, Morales-Nebreda L, Wunderink RG. Clinical Features of COVID-19 and Differentiation from Other Causes of CAP. Semin Respir Crit Care Med 2023; 44:8-20. [PMID: 36646082 DOI: 10.1055/s-0042-1759889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, one of the most common reasons for infection-related death worldwide. Causes of CAP include numerous viral, bacterial, and fungal pathogens, though frequently no specific organism is found. Beginning in 2019, the COVID-19 pandemic has caused incredible morbidity and mortality. COVID-19 has many features typical of CAP such as fever, respiratory distress, and cough, and can be difficult to distinguish from other types of CAP. Here, we highlight unique clinical features of COVID-19 pneumonia such as olfactory and gustatory dysfunction, lymphopenia, and distinct imaging appearance.
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Affiliation(s)
- Catherine A Gao
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chiagozie I Pickens
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Luisa Morales-Nebreda
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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13
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The Role of Biomarkers in Influenza and COVID-19 Community-Acquired Pneumonia in Adults. Antibiotics (Basel) 2023; 12:antibiotics12010161. [PMID: 36671362 PMCID: PMC9854478 DOI: 10.3390/antibiotics12010161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Pneumonia is a growing problem worldwide and remains an important cause of morbidity, hospitalizations, intensive care unit admission and mortality. Viruses are the causative agents in almost a fourth of cases of community-acquired pneumonia (CAP) in adults, with an important representation of influenza virus and SARS-CoV-2 pneumonia. Moreover, mixed viral and bacterial pneumonia is common and a risk factor for severity of disease. It is critical for clinicians the early identification of the pathogen causing infection to avoid inappropriate antibiotics, as well as to predict clinical outcomes. It has been extensively reported that biomarkers could be useful for these purposes. This review describe current evidence and provide recommendations about the use of biomarkers in influenza and SARS-CoV-2 pneumonia, focusing mainly on procalcitonin (PCT) and C-reactive protein (CRP). Evidence was based on a qualitative analysis of the available scientific literature (meta-analyses, randomized controlled trials, observational studies and clinical guidelines). Both PCT and CRP levels provide valuable information about the prognosis of influenza and SARS-CoV-2 pneumonia. Additionally, PCT levels, considered along with other clinical, radiological and laboratory data, are useful for early diagnosis of mixed viral and bacterial CAP, allowing the proper management of the disease and adequate antibiotics prescription. The authors propose a practical PCT algorithm for clinical decision-making to guide antibiotic initiation in cases of influenza and SARS-CoV-2 pneumonia. Further well-design studies are needed to validate PCT algorithm among these patients and to confirm whether other biomarkers are indeed useful as diagnostic or prognostic tools in viral pneumonia.
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14
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Kuznetsov KO, Tukbaeva LR, Kazakova VV, Mirzoeva KR, Bogomolova EA, Salakhutdinova AI, Ponomareva DY, Garipova AR, Mutsolgova MSM, Galimkhanov AG, Sakhibgareev MI, Guzhvieva ER. The Role of COVID-19 in Antibiotic Resistance in Pediatric Population. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v19i6.2465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is data on the irrational use of antimicrobial drugs in pediatric population during the COVID-19 pandemic. This could lead to potential development of antibiotic resistance and increased morbidity and mortality among this vulnerable population group. The aim of this review is to study the role of COVID-19 in antimicrobial drugs administration and antibiotic resistance development, as well as to determine a set of measures for its prevention. Recent studies results have shown that COVID-19 pandemic had both direct and indirect impact on antibiotic resistance development in pediatric population. The COVID-19 outbreak has revealed weaknesses in health systems around the world. Antibiotics administration in patients with coronavirus infection during this period exceeded the number of cases with bacterial co-infection or other diseases. Thus, it indicates irrational antibiotic treatment. There were cases of inappropriate antibiotics administration during the crisis caused by the COVID-19 pandemic even in regions with long-term rational antibiotic treatment programs. One of the most viable methods to combat antibiotic resistance is to improve approaches in health care and to increase preparedness to infectious outbreaks. Increasing clinical competence of medical workers, accessibility of medical facilities, permanent supply of high-quality and cheap antibiotics, vaccines, reducing COVID-19 testing time, and adequate administration of antibacterial agents are the measures that can prevent diseases caused by drug resistance. All stakeholders (health authorities, regulating authorities, politicians, scientific community, pharmaceutical companies) have to collaborate and achieve results to implement all the mentioned above protection measures.
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15
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TLRs Gene Polymorphisms Associated with Pneumonia before and during COVID-19 Pandemic. Diagnostics (Basel) 2022; 13:diagnostics13010121. [PMID: 36611413 PMCID: PMC9818199 DOI: 10.3390/diagnostics13010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The progression of infectious diseases depends on the characteristics of a patient's innate immunity, and the efficiency of an immune system depends on the patient's genetic factors, including SNPs in the TLR genes. In this pilot study, we determined the frequency of alleles in these SNPs in a subset of patients with pneumonia. METHODS This study assessed six SNPs from TLR genes: rs5743551 (TLR1), rs5743708, rs3804100 (TLR2), rs4986790 (TLR4), rs5743810 (TLR6), and rs3764880 (TLR8). Three groups of patients participated in this study: patients with pneumonia in 2019 (76 samples), patients with pneumonia caused by SARS-CoV-2 in 2021 (85 samples), and the control group (99 samples). RESULTS The allele and genotype frequencies obtained for each group were examined using four genetic models. Significant results were obtained when comparing the samples obtained from individuals with pneumonia before the spread of SARS-CoV-2 and from the controls for rs5743551 (TLR1) and rs3764880 (TLR8). Additionally, the comparison of COVID-19-related pneumonia cases and the control group revealed a significant result for rs3804100-G (TLR2). CONCLUSIONS Determining SNP allele frequencies and searching for their associations with the course of pneumonia are important for personalized patient management. However, our results need to be comprehensively assessed in consideration of other clinical parameters.
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16
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Omer I, Abuthiyab N, Al Zaid N, Alkanani R, Abualnaja R, Khan G. Procalcitonin as a Tool to Antimicrobial Stewardship in COVID-19 Patients with Superimposed Bacterial Infections: A Systematic Review. J Inflamm Res 2022; 15:6055-6064. [PMID: 36353123 PMCID: PMC9639592 DOI: 10.2147/jir.s377644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/20/2022] [Indexed: 07/30/2023] Open
Abstract
ABSTRACT Procalcitonin is an inflammatory marker that had shown marked potential as an antimicrobial stewardship tool for administering antibiotics when needed in patients with pneumonia as it raises concurrently with other inflammatory markers, yet no systematic review has assessed its potential in COVID-19 patients. This systematic review aimed to assess the potential appropriateness of procalcitonin as an antimicrobial stewardship tool in COVID-19 patients with superimposed bacterial and non-bacterial infections. All study designs published after 2019 were included in this systematic review. We included all studies that had reported procalcitonin levels in COVID-19 patients with suspected superimposed secondary infection(s). We searched MEDLINE, Scopus, and the Directory for Open Access Journal from April 2022 to May 2022 and retrieved all related articles for screening with no restrictions on language. We conducted risk of bias assessment according to the Critical Appraisal Skills Programme (CASP) criteria for cohort and case-control studies. Results were presented according to procalcitonin cut-off values, gold standard test used to confirm infection, and overall study conclusion(s), among other variables. This systematic review included 18 articles with 7196 patients in 8 countries. Despite different cut-off values of procalcitonin used, thirteen studies had indicated the appropriateness of using procalcitonin as antimicrobial stewardship tool in COVID-19 patients. We urge physicians to take this into account when treating COVID-19 patients suspected of superimposed infections and we look forward to further studies with standardized procalcitonin cut-off values that may provide appropriate quantitative data that can contribute to clinical guidelines. REGISTRATION PROSPERO CRD42022315013.
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Affiliation(s)
- Ibrahim Omer
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Noorah Abuthiyab
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Nura Al Zaid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Raghad Alkanani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Reema Abualnaja
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ghadeer Khan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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Abstract
Pulmonary Opacities - What Lies Beneath? Abstract. Abstract: Pulmonary opacities are among the most common findings that general practitioners and internists have to interpret in everyday life. Conventional chest x-rays are still important, but computed tomograms often provide additional information. Patient history, clinical examination but also additionally collected laboratory findings are important prerequisites for the interpretation of imaging studies. Likewise, radiological patterns should be recognized and correctly described. The density, distribution to one or both sides, basal or apical, unifocal or multifocal, also the involvement of the interstitial tissue, bronchioles, the alveolar space and pleura can provide decisive differential diagnostic information. Space-occupying or shrinking processes may be suspected on behalf of the course of pleural lines. Tumours may be differentiated from shrinking lung volume as seen in atelectasis by shift of the mediastinum or the shape of pleural lines. Occasionally control images can support the interpretation of the radiological results.
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Affiliation(s)
- Robert Thurnheer
- Klinik für Innere Medizin, Kantonsspital, Münsterlingen, Schweiz
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18
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SHEA statement on antibiotic stewardship in hospitals during public health emergencies. Infect Control Hosp Epidemiol 2022; 43:1541-1552. [PMID: 36102000 PMCID: PMC9672827 DOI: 10.1017/ice.2022.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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19
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The Association between Admission Procalcitonin Level and The Severity of COVID-19 Pneumonia: A Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101389. [PMID: 36295550 PMCID: PMC9611309 DOI: 10.3390/medicina58101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022]
Abstract
Background and Objectives: An elevated procalcitonin level has classically been linked to bacterial infections. Data on the association between elevated procalcitonin and the outcome of coronavirus disease 2019 (COVID-19) are conflicting. Some linked it to associated bacterial co-infections, while others correlated the elevation with disease severity without coexisting bacterial infections. We aimed to investigate the association between high procalcitonin and the severity of COVID-19. Materials and Methods: Hospitalized patients with confirmed COVID-19 pneumonia were divided into two groups: the normal-procalcitonin group and the high-procalcitonin group (>0.05 ng/mL). Patients with concomitant bacterial infections on admission were excluded. The primary outcomes were the need for intensive care unit (ICU) admission, progression to invasive mechanical ventilation (IMV), and in-hospital 28-day mortality. Results: We included 260 patients in the normal procalcitonin group and 397 patients in the high procalcitonin group. The mean age was 55 years and 49% were females. A higher number of patients in the elevated procalcitonin group required ICU admission (32.7% vs. 16.2%, p < 0.001) and IMV (27.2% vs. 13.5%, p < 0.001). In-hospital mortality was significantly higher in the elevated procalcitonin group (18.9% vs. 8.5%, p < 0.001). After adjusting for other covariates, procalcitonin > 0.05 ng/mL was an independent predictor of progression to IMV (OR, 1.71; 95% CI, 1.08−2.71; p = 0.022), ICU admission (OR, 1.73; 95% CI, 1.13−2.66; p = 0.011), and in-hospital mortality (OR, 1.99; 95% CI, 1.14−3.47; p = 0.015). An elevated procalcitonin level was the strongest predictor of in-hospital mortality. Conclusions: Measurement of procalcitonin can have a prognostic role among COVID-19 patients. The admission procalcitonin level can identify patients at risk of ICU admission, progression to IMV, and in-hospital mortality.
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Alhoufie ST, Ibrahim NA, Alsharif NH, Alfarouk KO, Makhdoom HM, Aljabri KR, Saeed SH, Khoumaeys AA, Almutawif YA, Najim MA, Ali HM, Aljifri AA, Kheyami AM, Alhazmi AA. Seroprevalence of community-acquired atypical bacterial pneumonia among adult COVID-19 patients from a single center in Al Madinah Al Munawarah, Saudi Arabia: A retrospective cohort study. Saudi Med J 2022; 43:1000-1006. [PMID: 36104051 PMCID: PMC9987659 DOI: 10.15537/smj.2022.43.9.20220379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the seroprevalence of the community-acquired bacterial that causes atypical pneumonia among confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) patients. METHODS In this cohort study, we retrospectively investigated the seroprevalence of Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila among randomly selected 189 confirmed COVID-19 patients at their time of hospital presentation via commercial immunoglobulin M (IgM) antibodies against these bacteria. We also carried out quantitative measurements of procalcitonin in patients' serum. RESULTS The seropositivity for L. pneumophila was 12.6%, with significant distribution among patientsolder than 50 years (χ2 test, p=0.009), while those of M. pneumoniae was 6.3% and C. pneumoniae was 2.1%, indicating an overall co-infection rate of 21% among COVID-19 patients. No significant difference (χ2 test, p=0.628) in the distribution of bacterial co-infections existed between male and female patients. Procalcitonin positivity was confirmed amongst 5% of co-infected patients. CONCLUSION Our study documented the seroprevalence of community-acquired bacteria co-infection among COVID-19 patients. In this study, procalcitonin was an inconclusive biomarker for non-severe bacterial co-infections among COVID-19 patients. Consideration and proper detection of community-acquired bacterial co-infection may minimize misdiagnosis during the current pandemic and positively reflect disease management and prognosis.
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Affiliation(s)
- Sari T Alhoufie
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Nadir A Ibrahim
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Naif H Alsharif
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Khalid O Alfarouk
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Hatim M Makhdoom
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Khaled R Aljabri
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Sayed H Saeed
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Adnan A Khoumaeys
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Yahya A Almutawif
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Mustafa A Najim
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Hamza M Ali
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Alanoud A Aljifri
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Ali M Kheyami
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Areej A Alhazmi
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
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Tang Y, Zhou Q. Changes in Serum CRP and PCT Levels in Patients with Acute Simple Lower Urinary Tract Infection and Evaluation of the Efficacy of Treatment with Shuangdong Capsules. Emerg Med Int 2022; 2022:9750237. [PMID: 36052218 PMCID: PMC9427299 DOI: 10.1155/2022/9750237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study is to investigate the changes and significance of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in patients with acute simple lower urinary tract infection (ALUTI) and to analyze the efficacy of treatment with Shuangdong capsules, so as to provide a basis for the rational clinical application of drugs. Methods 92 patients with ALUTI (observation group) were randomly divided into 46 cases each in group A and group B. Group A was treated with basic anti-infective drugs, while group B was treated with Shuangdong capsules, and the duration of treatment in both groups was 14 days. The curative effect of the two groups was analyzed, and the changes in serum PCT and CRP levels were compared before and after treatment and compared with 40 healthy people in the control group. Results The serum PCT and CRP levels, the number of urinary leukocyte count (LEU), and the number of urinary bacterial count (BACT) were significantly higher in Group A and Group B than in the healthy control group before treatment (P < 0.05). After treatment, the total clinical efficiency of patients in group B (97.83%) was significantly higher than that in group A (78.26%) (P < 0.05). The serum PCT and CRP levels, the number of urinary LEU, and the number of urinary BACT decreased in both groups after treatment compared with those before treatment, and all of them were significantly lower in group B than in group A (P < 0.05). The area under the curve (AUC) values of serum PCT and CRP levels for the diagnosis of acute simple lower urinary tract infection were 0.747 (95% CI 0.633-0.860) and 0.926 (95% CI 0.870∼0.982), both with high sensitivity and specificity. Conclusion The Shuangdong capsule combined with conventional antibacterial drugs has better clinical efficacy in the treatment of acute simple lower urinary tract infection; serum CRP and PCT levels in patients with acute simple lower urinary tract infection can be used as indicators for diagnosis and efficacy determination of the infection.
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Affiliation(s)
- Yachun Tang
- The Affiliated Nanhua Hospital, Department of Urology, Hengyang Medical School, Universitity of South China, Hengyang 421002, Hunan, China
| | - Qun Zhou
- The Affiliated Nanhua Hospital, Department of Urology, Hengyang Medical School, Universitity of South China, Hengyang 421002, Hunan, China
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Diagnostic Accuracy of Procalcitonin upon Emergency Department Admission during SARS-CoV-2 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11091141. [PMID: 36139922 PMCID: PMC9495046 DOI: 10.3390/antibiotics11091141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 01/08/2023] Open
Abstract
Highlights Abstract Introduction: Procalcitonin is a marker for bacterial diseases and has been used to guide antibiotic prescription. Procalcitonin accuracy, measured at admission, in patients with community-acquired pneumonia (CAP), is unknown in the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Objectives: To evaluate the diagnostic accuracy of procalcitonin to assess the need for antibiotic treatment in patients with CAP presenting to the emergency department during the SARS-CoV-2 pandemic. Methods: We performed a real-world diagnostic retrospective accuracy study of procalcitonin in patients admitted to the emergency department. Measures of diagnostic accuracy were calculated based on procalcitonin results compared to the reference standard of combined microbiological and radiological analysis. Sensitivity, specificity, positive and negative predictive values, and area under (AUC) the receiver-operating characteristic (ROC) curve were calculated in two analyses: first assessing procalcitonin ability to differentiate microbiologically proven bacteria from viral CAP and then clinically diagnosed bacterial CAP from viral CAP. Results: When using a procalcitonin threshold of 0.5 ng/mL to identify bacterial etiology within patients with CAP, we observed sensitivity and specificity of 50% and 64.1%, and 43% and 82.6%, respectively, in the two analyses. The positive and negative predictive values of a procalcitonin threshold of 0.5 ng/mL to identify patients for whom antibiotics should be advised were 46.4% and 79.7%, and 48.9% and 79% in the two analyses, respectively. The AUC for the two analyses was 0.60 (95% confidence interval [CI] 0.52–0.68) and 0.62 (95% CI, 0.55–0.69). Conclusions: Procalcitonin measured upon admission during the SARS-CoV-2 pandemic should not guide antibiotic treatment in patients with CAP.
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So W, Simon MS, Choi JJ, Wang TZ, Williams SC, Chua J, Kubin CJ. Characteristics of procalcitonin in hospitalized COVID-19 patients and clinical outcomes of antibiotic use stratified by procalcitonin levels. Intern Emerg Med 2022; 17:1405-1412. [PMID: 35277828 PMCID: PMC8916484 DOI: 10.1007/s11739-022-02955-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/22/2022] [Indexed: 12/28/2022]
Abstract
We examined the characteristics of pro-calcitonin (PCT) in hospitalized COVID-19 patients (cohort 1) and clinical outcomes of antibiotic use stratified by PCT in non-critically ill patients without bacterial co-infection (cohort 2). Retrospective reviews were performed in adult, hospitalized COVID-19 patients during March-May 2020. For cohort 1, we excluded hospital transfers, renal disease and extra-pulmonary infection without isolated pathogen(s). For cohort 2, we further excluded microbiologically confirmed infection, 'do not resuscitate ± do not intubate' status, and intensive care unit (ICU). For cohort 1, PCT was compared between absent/low-suspicion and proven bacterial co-infections. Factors associated with elevated PCT and sensitivity/specificity/PPV/NPV of PCT cutoffs for identifying bacterial co-infections were explored. For cohort 2, clinical outcomes including mechanical ventilation within 5 days (MV5) were compared between the antibiotic and non-antibiotic groups stratified by PCT ≥ 0.25 µg/L. Nine hundred and twenty four non-ICU and 103 ICU patients were included (cohort 1). The median PCT was higher in proven vs. absent/low-suspicion of bacterial co-infection. Elevated PCT was significantly associated with proven bacterial co-infection, ICU status and oxygen requirement. For PCT ≥ 0.25 µg/L, sensitivity/specificity/PPV/NPV were 69/65/6.5/98% (non-ICU) and 75/33/8.6/94% (ICU). For cohort 2, 756/1305 (58%) patients were included. Baseline characteristics were balanced between the antibiotic and non-antibiotic groups except PCT ≥ 0.25 µg/L (antibiotic:non-antibiotic = 59%:24%) and tocilizumab use (antibiotic:non-antibiotic = 5%:2%). 23% (PCT < 0.25 µg/L) and 58% (PCT ≥ 0.25 µg/L) received antibiotics. Antibiotic group had significantly higher rates of MV5. COVID-19 severity inferred from ICU status and oxygen requirement as well as the presence of bacterial co-infections were associated with elevated PCT. PCT showed poor PPV and high NPV for proven bacterial co-infections. The use of antibiotics did not show improved clinical outcomes in COVID-19 patients with PCT ≥ 0.25 µg/L outside of ICU when bacterial co-infections are of low suspicion.
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Affiliation(s)
- Wonhee So
- Western University of Health Sciences, 309 E 2nd st, Pomona, CA, 91766, USA.
| | - Matthew S Simon
- NewYork-Presbyterian Weill Cornell Medical Center, 525 E. 68th st, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Justin J Choi
- NewYork-Presbyterian Weill Cornell Medical Center, 525 E. 68th st, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Tina Z Wang
- Department of Medicine, Columbia University, New York, NY, USA
| | - Samuel C Williams
- Weill Cornell-MSKCC-Rockefeller University Tri Institutional MD-PhD Program, New York, NY, USA
| | - Jason Chua
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, New York, NY, USA
| | - Christine J Kubin
- Department of Medicine, Columbia University, New York, NY, USA
- NewYork-Presbyterian Columbia University Irving Medical Center, 630 W. 168th st, New York, NY, USA
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Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients. J Infect 2022; 85:374-381. [PMID: 35781017 PMCID: PMC9245395 DOI: 10.1016/j.jinf.2022.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 01/08/2023]
Abstract
Background : Procalcitonin (PCT) and C-Reactive Protein (CRP) are useful biomarkers to differentiate bacterial from viral or fungal infections, although the association between them and co-infection or mortality in COVID-19 remains unclear. Methods : The study represents a retrospective cohort study of patients admitted for COVID-19 pneumonia to 84 ICUs from ten countries between (March 2020-January 2021). Primary outcome was to determine whether PCT or CRP at admission could predict community-acquired bacterial respiratory co-infection (BC) and its added clinical value by determining the best discriminating cut-off values. Secondary outcome was to investigate its association with mortality. To evaluate the main outcome, a binary logistic regression was performed. The area under the curve evaluated diagnostic performance for BC prediction. Results : 4635 patients were included, 7.6% fulfilled BC diagnosis. PCT (0.25[IQR 0.1-0.7] versus 0.20[IQR 0.1-0.5]ng/mL, p<0.001) and CRP (14.8[IQR 8.2-23.8] versus 13.3 [7-21.7]mg/dL, p=0.01) were higher in BC group. Neither PCT nor CRP were independently associated with BC and both had a poor ability to predict BC (AUC for PCT 0.56, for CRP 0.54). Baseline values of PCT<0.3ng/mL, could be helpful to rule out BC (negative predictive value 91.1%) and PCT≥0.50ng/mL was associated with ICU mortality (OR 1.5,p<0.001). Conclusions : These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT<0.3ng/mL may be useful to rule out BC, providing clinicians a valuable tool to guide antibiotic stewardship and allowing the unjustified overuse of antibiotics observed during the pandemic, additionally PCT≥0.50ng/mL might predict worsening outcomes.
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Karun A, Kaur RJ, Charan J, Murti K, Ramesh M, Ravichandiran V, Dhingra S. Impact of COVID-19 on Antimicrobial Resistance in Paediatric Population: a Narrative Review. CURRENT PHARMACOLOGY REPORTS 2022; 8:365-375. [PMID: 35789932 PMCID: PMC9244284 DOI: 10.1007/s40495-022-00298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/08/2023]
Abstract
Purpose of Review Irrational use of antimicrobials has been reported in paediatric population during the COVID-19 time period. This may lead to potential development of antimicrobial resistance and increased morbidity and mortality among this vulnerable population. The purpose of this review is to ascertain the impact of COVID-19 pandemic on antimicrobial resistance among paediatrics and the possible strategies to minimize the menace of antimicrobial resistance. Recent Findings Recent findings indicate that the COVID-19 pandemic has direct as well as indirect impact on the development of antimicrobial resistance among paediatric population. Summary This review article shows the impact of COVID-19 on the development of antimicrobial resistance and strategies to prevent it with special reference to antimicrobial stewardship programmes among paediatric population.
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Patel N, Adams C, Brunetti L, Bargoud C, Teichman AL, Choron RL. Evaluation of Procalcitonin's Utility to Predict Concomitant Bacterial Pneumonia in Critically Ill COVID-19 Patients. J Intensive Care Med 2022; 37:1486-1492. [PMID: 35711161 PMCID: PMC9207592 DOI: 10.1177/08850666221108636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Historically, procalcitonin(PCT) has been used as a
predictor of bacterial infection and to guide antibiotic therapy in hospitalized
patients. The purpose of this study was to determine PCT's diagnostic utility in
predicting secondary bacterial pneumonia in critically ill patients with severe
COVID-19 pneumonia. Methods: A retrospective cohort study was
conducted in COVID-19 adults admitted to the ICU between March 2020, and March
2021. All included patients had a PCT level within 72 h of presentation and
serum creatinine of <1.5mg/dL. A PCT threshold of 0.5ng/mL was used to
compare patients with high( ≥ 0.5ng/mL) versus low(< 0.5ng/mL) PCT. Bacterial
pneumonia was defined by positive respiratory culture. A receiver operating
characteristics (ROC) curve was utilized to evaluate PCT as a diagnostic test
for bacterial pneumonia, with an area under the curve(AUC) threshold of 0.7 to
signify an accurate diagnostic test. A multivariable model was constructed to
identify variables associated with in-hospital mortality. Results:
There were 165 patients included: 127 low PCT versus 38 high PCT. There was no
significant difference in baseline characteristics, vital signs, severity of
disease, or outcomes among low versus high PCT groups (all
p > 0.05). While there was no difference in bacterial
pneumonia in low versus high groups (34(26.8%) versus 12(31.6%),
p = 0.562), more patients in the high PCT
group had bacteremia (19(15%) versus 11(28.9%),
p = 0.050). Sensitivity was 26.1% and
specificity was 78.2% for PCT to predict bacterial pneumonia coinfection in ICU
patients with COVID-19 pneumonia. ROC yielded an AUC 0.54
(p = 0.415). After adjusting for LDH>350U/L and creatinine
in multivariable regression, PCT did not enhance performance of the regression
model. Conclusions: PCT offers little to no predictive utility in
diagnosing concomitant bacterial pneumonia in critically ill patients with
COVID-19 nor in predicting increased severity of disease or worse outcomes
including mortality.
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Affiliation(s)
- Nandini Patel
- 15484Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA
| | - Christopher Adams
- 15484Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA.,43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA
| | - Luigi Brunetti
- 15484Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA.,43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA
| | | | - Amanda L Teichman
- 43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA.,43982Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Rachel L Choron
- 43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA.,43982Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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Cohen AJ, Glick LR, Lee S, Kunitomo Y, Tsang DA, Pitafi S, Toro PV, Zhang E, Datta R, Dela Cruz CS, Gautam S. Nonutility of procalcitonin for diagnosing bacterial pneumonia in COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.03.29.22272960. [PMID: 35411344 PMCID: PMC8996631 DOI: 10.1101/2022.03.29.22272960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patients hospitalized with COVID-19 are at significant risk for superimposed bacterial pneumonia. However, diagnosing superinfection is challenging due to its clinical resemblance to severe COVID-19. We therefore evaluated whether the immune biomarker, procalcitonin, could facilitate the diagnosis of bacterial superinfection. To do so, we identified 185 patients with severe COVID-19 who underwent lower respiratory culture; 85 had superinfection. Receiver operating characteristic curve analysis showed that procalcitonin at the time of culture was incapable of distinguishing patients with bacterial infection (AUC, 0.52). We conclude that static measurement of procalcitonin does not aid in the diagnosis of superinfection in severe COVID-19.
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Moreno-García E, Puerta-Alcalde P, Letona L, Meira F, Dueñas G, Chumbita M, Garcia-Pouton N, Monzó P, Lopera C, Serra L, Cardozo C, Hernandez-Meneses M, Rico V, Bodro M, Morata L, Fernandez-Pittol M, Grafia I, Castro P, Mensa J, Martínez JA, Sanjuan G, Marcos MA, Soriano A, Garcia-Vidal C. Bacterial co-infection at hospital admission in patients with COVID-19. Int J Infect Dis 2022; 118:197-202. [PMID: 35257905 PMCID: PMC8896874 DOI: 10.1016/j.ijid.2022.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19. Methods Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020–February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included. Results A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p<0.001, and p<0.001, respectively). In multivariate analysis, oxygen saturation ≤94% (OR 2.47, CI 1.57–3.86), ferritin levels <338 ng/mL (OR 2.63, CI 1.69–4.07), and PCT higher than 0.2 ng/mL (OR 1.74, CI 1.11–2.72) were independent risk factors for co-infection at hospital admission owing to COVID-19. Conclusions Bacterial co-infection in patients hospitalized for COVID-19 is relatively common. However, clinicians could spare antibiotics in patients with PCT values <0.2, especially with high ferritin values and oxygen saturation >94%.
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Affiliation(s)
- Estela Moreno-García
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | - Laura Letona
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Fernanda Meira
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Gerard Dueñas
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Patricia Monzó
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Laia Serra
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Marta Hernandez-Meneses
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Verónica Rico
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Ignacio Grafia
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Sanjuan
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Mª Angeles Marcos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain.; Medical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain..
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29
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Atallah NJ, Warren HM, Roberts MB, Elshaboury RH, Bidell MR, Gandhi RG, Adamsick M, Ibrahim MK, Sood R, Bou Zein Eddine S, Cobler-Lichter MJ, Alexander NJ, Timmer KD, Atallah CJ, Viens AL, Panossian VS, Scherer AK, Proctor T, Smartt S, Letourneau AR, Paras ML, Johannes S, Wiemer J, Mansour MK. Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study. PLoS One 2022; 17:e0262342. [PMID: 35025929 PMCID: PMC8758006 DOI: 10.1371/journal.pone.0262342] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Coronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). METHODS Adult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records. RESULTS 324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia. CONCLUSIONS Baseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.
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Affiliation(s)
- Natalie J. Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
| | - Hailey M. Warren
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Matthew B. Roberts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ramy H. Elshaboury
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Monique R. Bidell
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ronak G. Gandhi
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Meagan Adamsick
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States of America
| | - Maryam K. Ibrahim
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rupali Sood
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Savo Bou Zein Eddine
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Natalie J. Alexander
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kyle D. Timmer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Adam L. Viens
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Vahe S. Panossian
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Allison K. Scherer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Teddie Proctor
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Sherrie Smartt
- Fisher Diagnostics, Part of Thermo Fisher Scientific, Middletown, VA, United States of America
| | - Alyssa R. Letourneau
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Molly L. Paras
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sascha Johannes
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Jan Wiemer
- B·R·A·H·M·S GmbH, Part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Michael K. Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail: (MM); (NA)
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30
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Van Laethem J, Wuyts S, Van Laere S, Koulalis J, Colman M, Moretti M, Seyler L, De Waele E, Pierard D, Lacor P, Allard SD. Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers. Intern Emerg Med 2022; 17:141-151. [PMID: 34185257 PMCID: PMC8239323 DOI: 10.1007/s11739-021-02790-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022]
Abstract
This study aims to quantify antibiotic consumption for suspected respiratory tract superinfections in COVID-19 patients, while investigating the associated drivers of antibiotic prescribing in light of the current signs of antibiotic overuse. Adult patients with a positive COVID-19 diagnosis admitted to a Belgian 721-bed university hospital were analyzed retrospectively (March 11th-May 4th, 2020), excluding short-term admissions (< 24 h). Antibiotic prescriptions were analyzed and quantified, using Defined Daily Doses (DDD) per admission and per 100 bed days. Possible drivers of antibiotic prescribing were identified by means of mixed effects logistic modelling analysis with backwards selection. Of all included admissions (n = 429), 39% (n = 171) were prescribed antibiotics for (presumed) respiratory tract superinfection (3.6 DDD/admission; 31.5 DDD/100 bed days). Consumption of beta-lactamase inhibitor-penicillin combinations was the highest (2.55 DDD/admission; 23.3 DDD/100 bed days). Four drivers were identified: fever on admission (OR 2.97; 95% CI 1.42-6.22), lower SpO2/FiO2 ratio on admission (OR 0.96; 95% CI 0.92-0.99), underlying pulmonary disease (OR 3.04; 95% CI 1.12-8.27) and longer hospital stay (OR 1.09; 95% CI 1.03-1.16). We present detailed quantitative antibiotic data for presumed respiratory tract superinfections in hospitalized COVID-19 patients. In addition to knowledge on antibiotic consumption, we hope antimicrobial stewardship programs will be able to use the drivers identified in this study to optimize their interventions in COVID-19 wards.
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Affiliation(s)
- J Van Laethem
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium.
| | - S Wuyts
- Hospital Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Research Group Clinical Pharmacology and Pharmacotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Van Laere
- Interfaculty Centre Data Processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Koulalis
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Colman
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Moretti
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - L Seyler
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - E De Waele
- Intensive Care Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - D Pierard
- Microbiology Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - P Lacor
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - S D Allard
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
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31
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Presumed Urinary Tract Infection in Patients Admitted with COVID-19: Are We Treating Too Much? Antibiotics (Basel) 2021; 10:antibiotics10121493. [PMID: 34943705 PMCID: PMC8698875 DOI: 10.3390/antibiotics10121493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023] Open
Abstract
Despite the low rates of bacterial co-/superinfections in COVID-19 patients, antimicrobial drug use has been liberal since the start of the COVID-19 pandemic. Due to the low specificity of markers of bacterial co-/superinfection in the COVID-19 setting, overdiagnosis and antimicrobial overprescription have become widespread. A quantitative and qualitative evaluation of urinary tract infection (UTI) diagnoses and antimicrobial drug prescriptions for UTI diagnoses was performed in patients admitted to the COVID-19 ward of a university hospital between 17 March and 2 November 2020. A team of infectious disease specialists performed an appropriateness evaluation for every diagnosis of UTI and every antimicrobial drug prescription covering a UTI. A driver analysis was performed to identify factors increasing the odds of UTI (over)diagnosis. A total of 622 patients were included. UTI was present in 13% of included admissions, and in 12%, antimicrobials were initiated for a UTI diagnosis (0.71 daily defined doses (DDDs)/admission; 22% were scored as ‘appropriate’). An evaluation of UTI diagnoses by ID specialists revealed that of the 79 UTI diagnoses, 61% were classified as probable overdiagnosis related to the COVID-19 hospitalization. The following factors were associated with UTI overdiagnosis: physicians who are unfamiliar working in an internal medicine ward, urinary incontinence, mechanical ventilation and female sex. Antimicrobial stewardship teams should focus on diagnostic stewardship of UTIs, as UTI overdiagnosis seems to be highly prevalent in admitted COVID-19 patients.
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32
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Houghton R, Moore N, Williams R, El-Bakri F, Peters J, Mori M, Vernet G, Lynch J, Lewis H, Tavener M, Durham T, Bowyer J, Saeed K, Pollara G. C-reactive protein-guided use of procalcitonin in COVID-19. JAC Antimicrob Resist 2021; 3:dlab180. [PMID: 34859223 PMCID: PMC8633792 DOI: 10.1093/jacamr/dlab180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 01/31/2023] Open
Abstract
Background A low procalcitonin (PCT) concentration facilitates exclusion of bacterial co-infections in COVID-19, but high costs associated with PCT measurements preclude universal adoption. Changes in inflammatory markers, including C-reactive protein (CRP), can be concordant, and predicting low PCT concentrations may avoid costs of redundant tests and support more cost-effective deployment of this diagnostic biomarker. Objectives To explore whether, in COVID-19, low PCT values could be predicted by the presence of low CRP concentrations. Methods Unselected cohort of 224 COVID-19 patients admitted to hospital that underwent daily PCT and CRP measurements as standard care. Both 0.25 ng/mL and 0.5 ng/mL were used as cut-offs for positive PCT test results. Geometric mean was used to define high and low CRP values at each timepoint assessed. Results Admission PCT was <0.25 ng/mL in 160/224 (71.4%), 0.25–0.5 ng/mL in 27 (12.0%) and >0.5 ng/mL in 37 (16.5%). Elevated PCT was associated with increased risk of death (P = 0.0004) and was more commonly associated with microbiological evidence of bacterial co-infection (P < 0.0001). For high CRP values, significant heterogeneity in PCT measurements was observed, with maximal positive predictive value of 50% even for a PCT cut-off of 0.25 ng/mL. In contrast, low CRP was strongly predictive of low PCT concentrations, particularly <0.5 ng/mL, with a negative predictive value of 97.6% at time of hospital admission and 100% 48 hours into hospital stay. Conclusions CRP-guided PCT testing algorithms can reduce unnecessary PCT measurement and costs, supporting antimicrobial stewardship strategies in COVID-19.
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Affiliation(s)
| | - Nathan Moore
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | | | | | | | - Matilde Mori
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | | | - Jessica Lynch
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Henry Lewis
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | | | - Tom Durham
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Jack Bowyer
- Hampshire Hospitals NHS Foundation Trust, Hampshire, UK
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Medicine, University of Southampton, Southampton, UK
| | - Gabriele Pollara
- Royal Free London NHS Foundation Trust, London, UK.,University College London, London, UK
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33
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Stevens RW, Jensen K, Kooda K, Mara K, O'Horo JC, Shah A. A retrospective antibiotic prescribing assessment and examination of potential antibiotic stewardship targets in patients with COVID-19. JAC Antimicrob Resist 2021; 3:dlab170. [PMID: 34755114 PMCID: PMC8569441 DOI: 10.1093/jacamr/dlab170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives Despite low rates of bacterial coinfection in patients admitted with COVID-19, antimicrobials are frequently prescribed. Our primary objective was to evaluate antimicrobial prescribing over time in patients admitted with COVID-19. The secondary objectives were to evaluate the role of ID providers in antimicrobial utilization, describe the rate of confirmed bacterial infection and determine factors associated with empirical antimicrobial prescribing in COVID-19. Materials and methods Retrospective review was performed for adult patients admitted to a tertiary care centre with COVID-19 between 1 March 2020 and 30 November 2020. Patient demographics, disease severity, risk factors for severe disease, clinical outcomes, antimicrobial prescribing and respiratory microbiological testing were collected and analysed. Prescribing trends were evaluated by month, and factors contributing to prescribing were established using univariate and multivariable analysis. Results Antibiotics were prescribed during admission in 37.9% of the study cohort, with 85.1% of patients who received antibiotics having therapy initiated within 48 h of admission. Antibiotic prescribing incidence increased with disease. Over the study period, antimicrobial prescribing rates decreased by 8.7% per month. Multivariable analysis found ICU admission, obtainment of procalcitonin values, intubation, heart failure, haemodialysis and nursing home residence were associated with empirical antimicrobial prescribing. Conclusions Unnecessary antimicrobial prescribing in patients with viral syndromes like COVID-19 continues to represent an area of concern. Antimicrobial stewardship efforts during COVID-19 should consider patient-specific factors associated with antibiotic prescribing. Recognition of such factors, in combination with application of well-established antimicrobial stewardship tactics, may serve to impact antimicrobial prescribing trends, even as patient volumes rise.
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Affiliation(s)
- Ryan W Stevens
- Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| | - Kelsey Jensen
- Department of Pharmacy Services, Mayo Clinic Health System, Austin, MN, USA
| | - Kirstin Kooda
- Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - John C O'Horo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aditya Shah
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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34
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Pierce J, Stevens MP. COVID-19 and antimicrobial stewardship: lessons learned, best practices, and future implications. Int J Infect Dis 2021; 113:103-108. [PMID: 34624517 PMCID: PMC8491953 DOI: 10.1016/j.ijid.2021.10.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 12/16/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a profound and often devastating impact on global healthcare systems. Healthcare systems have had to repurpose programs and staff as part of COVID-19 relief efforts. The infrastructure and skilled personnel of antimicrobial stewardship programs (ASPs) have been utilized in new ways as part of COVID-19 pandemic response efforts. A critical focus of ASPs both before and during the pandemic has been on limiting the development of antimicrobial resistance. Fortunately, existing data indicate that rates of bacterial co-infection are relatively low and ASPs should continue aggressive efforts to limit unnecessary antimicrobial use. ASPs have taken a lead role in COVID-19 focused guideline creation and curation, as well as in helping to steward access to potential novel therapeutic agents. Disparities in ASP program resources and personnel exist, and ASP activities focused on the COVID-19 response should be tailored to individual settings. There is an urgent need for research to help inform ASP best practices within pandemic response efforts that take into account local resources. Investment in infrastructure and personnel is urgently needed both in the context of current relief efforts and to prepare for future pandemics.
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Affiliation(s)
- Jacob Pierce
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University School of Medicine, 1000 E Marshall St., Richmond, VA 23298, USA.
| | - Michael P Stevens
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University School of Medicine, 1000 E Marshall St., Richmond, VA 23298, USA.
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35
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Antibiotic Prescriptions Targeting Bacterial Respiratory Infections in Admitted Patients with COVID-19: A Prospective Observational Study. Infect Dis Ther 2021; 10:2575-2591. [PMID: 34529255 PMCID: PMC8444524 DOI: 10.1007/s40121-021-00535-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis. Results Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis. Conclusion In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19. Trial Registration The study is registered at ClinicalTrials.gov (NCT04544072). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00535-2.
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Hausfater P, Charles PE. Le dosage de la procalcitonine peut-il être utile à la prise en charge d’une infection à SARS-CoV-2 aux urgences et en réanimation ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
De nombreuses études d’impact ont validé l’intérêt du dosage de la procalcitonine pour rationaliser les antibiothérapies dans les infections respiratoires basses. En l’absence d’étude prospective interventionnelle spécifiquement chez les patients atteints de Covid-19, le dosage de la procalcitonine peut cependant être utilisé aux urgences comme dans les autres IRB pour l’aide à la décision d’antibiothérapie. La majorité des infections à SARS-CoV-2 non compliquées ont des valeurs de procalcitonine inférieures à 0,25 μg/l. Parallèlement, des concentrations supérieures à 0,5 μg/l peuvent traduire un risque d’évolution vers une forme grave et/ou une co-infection bactérienne. En soins critiques, la procalcitonine est prometteuse chez les patients avec un syndrome de détresse respiratoire aiguë lié à la Covid. Chez ces patients, la pertinence de l’antibiothérapie est à reconsidérer quotidiennement, compte tenu du risque d’infection bactérienne qui évolue tout au long de séjours souvent prolongés, afin de réduire la sélection d’espèces résistantes et de limiter les toxicités.
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