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Abstract：
BACKGROUND: Procalcitonin (PCT) has been used as a biomarker to guide antibiotic therapy in various patient populations. However, its role in optimizing antibiotic use in COVID-19 patients has not been well studied to date. Thus, we aimed to evaluate the use of serial PCT monitoring as an antimicrobial stewardship tool for COVID-19 patients.
METHODS: This retrospective study included 240 COVID-19 patients who were admitted to a tertiary medical institution in Saudi Arabia between January 2020 and February 2022. Patients who received empiric antibiotic therapy for community-acquired pneumonia (CAP) and had serial procalcitonin levels were included. The patients were divided into two groups: the normal procalcitonin arm (PCT level < 0.5 ng/mL) and the elevated PCT arm (PCT level > 0.5 ng/mL). The primary and secondary outcomes were the effect of PCT monitoring on the duration of antibiotic exposure and the length of hospital stay, respectively. To measure the accuracy of PCT, the receiver-operating characteristic area under the curve (ROC-AUC) was determined.
RESULTS: Among the included patients, 142 were in the normal procalcitonin arm (median PCT, 0.12 ng/mL), and 78 were in the elevated PCT arm (median PCT, 4.04 ng/mL). The baseline characteristics were similar between the two arms, except for the higher prevalence of kidney disease in the elevated PCT arm. There was no statistically significant difference in the duration of antibiotic exposure between the normal and elevated PCT arms (median duration: 7 days in both arms). However, the length of hospital stay was significantly shorter in the normal PCT arm (median stay, 9 days) than in the elevated PCT arm (median stay, 13 days; p = 0.028). The ROC-AUC value was 0.54 (95% CI: 0.503-0.595).
CONCLUSIONS: Serial PCT monitoring did not lead to a reduction in the duration of antibiotic exposure in COVID-19 patients. However, it was associated with a shorter hospital stay. These findings suggest that PCT monitoring may be useful for optimizing antibiotic use and improving outcomes in COVID-19 patients. While PCT-guided algorithms have the potential to enable antibiotic stewardship, their role in the context of COVID-19 treatment requires further investigation.
METHODS: This retrospective study included 240 COVID-19 patients who were admitted to a tertiary medical institution in Saudi Arabia between January 2020 and February 2022. Patients who received empiric antibiotic therapy for community-acquired pneumonia (CAP) and had serial procalcitonin levels were included. The patients were divided into two groups: the normal procalcitonin arm (PCT level < 0.5 ng/mL) and the elevated PCT arm (PCT level > 0.5 ng/mL). The primary and secondary outcomes were the effect of PCT monitoring on the duration of antibiotic exposure and the length of hospital stay, respectively. To measure the accuracy of PCT, the receiver-operating characteristic area under the curve (ROC-AUC) was determined.
RESULTS: Among the included patients, 142 were in the normal procalcitonin arm (median PCT, 0.12 ng/mL), and 78 were in the elevated PCT arm (median PCT, 4.04 ng/mL). The baseline characteristics were similar between the two arms, except for the higher prevalence of kidney disease in the elevated PCT arm. There was no statistically significant difference in the duration of antibiotic exposure between the normal and elevated PCT arms (median duration: 7 days in both arms). However, the length of hospital stay was significantly shorter in the normal PCT arm (median stay, 9 days) than in the elevated PCT arm (median stay, 13 days; p = 0.028). The ROC-AUC value was 0.54 (95% CI: 0.503-0.595).
CONCLUSIONS: Serial PCT monitoring did not lead to a reduction in the duration of antibiotic exposure in COVID-19 patients. However, it was associated with a shorter hospital stay. These findings suggest that PCT monitoring may be useful for optimizing antibiotic use and improving outcomes in COVID-19 patients. While PCT-guided algorithms have the potential to enable antibiotic stewardship, their role in the context of COVID-19 treatment requires further investigation.
摘要：
背景：降钙素原（PCT）已被用作生物标志物，以指导各种患者人群的抗生素治疗。然而,迄今为止,其在优化COVID-19患者抗生素使用中的作用尚未得到充分研究.因此，我们旨在评估PCT系列监测作为COVID-19患者抗菌药物管理工具的应用.
方法：这项回顾性研究包括2020年1月至2022年2月在沙特阿拉伯一家三级医疗机构住院的240名COVID-19患者。包括接受经验性抗生素治疗社区获得性肺炎（CAP）并具有连续降钙素原水平的患者。将患者分为两组：正常降钙素原组（PCT水平<0.5ng/mL）和升高的PCT组（PCT水平>0.5ng/mL）。主要和次要结果是PCT监测对抗生素暴露持续时间和住院时间的影响。分别。为了测量PCT的准确性，测定受试者工作特征曲线下面积(ROC-AUC).
结果：在纳入的患者中，142人在正常降钙素原组(中位PCT，0.12ng/mL)，78人在升高的PCT组中(中位数PCT，4.04ng/mL)。两组的基线特征相似，除了升高的PCT组中肾脏疾病的患病率较高。正常和升高的PCT组之间的抗生素暴露持续时间没有统计学上的显着差异（中位持续时间：两组均为7天）。然而,PCT正常组的住院时间明显缩短(中位住院时间，9天）比升高的PCT臂（中位住院时间，13天；p=0.028）。ROC-AUC值为0.54(95%CI:0.503-0.595)。
结论：系列PCT监测并未导致COVID-19患者抗生素暴露持续时间减少。然而,这与住院时间较短有关。这些结果表明，PCT监测可能有助于优化COVID-19患者的抗生素使用和改善预后。虽然PCT指导的算法有可能实现抗生素管理，它们在COVID-19治疗中的作用需要进一步调查。
方法：这项回顾性研究包括2020年1月至2022年2月在沙特阿拉伯一家三级医疗机构住院的240名COVID-19患者。包括接受经验性抗生素治疗社区获得性肺炎（CAP）并具有连续降钙素原水平的患者。将患者分为两组：正常降钙素原组（PCT水平<0.5ng/mL）和升高的PCT组（PCT水平>0.5ng/mL）。主要和次要结果是PCT监测对抗生素暴露持续时间和住院时间的影响。分别。为了测量PCT的准确性，测定受试者工作特征曲线下面积(ROC-AUC).
结果：在纳入的患者中，142人在正常降钙素原组(中位PCT，0.12ng/mL)，78人在升高的PCT组中(中位数PCT，4.04ng/mL)。两组的基线特征相似，除了升高的PCT组中肾脏疾病的患病率较高。正常和升高的PCT组之间的抗生素暴露持续时间没有统计学上的显着差异（中位持续时间：两组均为7天）。然而,PCT正常组的住院时间明显缩短(中位住院时间，9天）比升高的PCT臂（中位住院时间，13天；p=0.028）。ROC-AUC值为0.54(95%CI:0.503-0.595)。
结论：系列PCT监测并未导致COVID-19患者抗生素暴露持续时间减少。然而,这与住院时间较短有关。这些结果表明，PCT监测可能有助于优化COVID-19患者的抗生素使用和改善预后。虽然PCT指导的算法有可能实现抗生素管理，它们在COVID-19治疗中的作用需要进一步调查。
