Impact of introducing procalcitonin testing on antibiotic usage in acute NHS hospitals during the first wave of COVID-19 in the UK: a controlled interrupted time series analysis of organization-level data. (8th February 2022)

• Record Type: Journal Article
• Authors: Llewelyn, Martin J.; Grozeva, Detelina; Howard, Philip; Euden, Joanne; Gerver, Sarah M.; Hope, Russell; Heginbothom, Margaret; Powell, Neil; Richman, Colin; Shaw, Dominick; Thomas-Jones, Emma; West, Robert M.; Carrol, Enitan D.; Pallmann, Philip; Sandoe, Jonathan A. T.
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 77:Number 4(2022)
• Page Start: 1189
• Page End: 1196
• Publication Date: 2022-02-08
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkac017
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract: Background: Blood biomarkers have the potential to help identify COVID-19 patients with bacterial coinfection in whom antibiotics are indicated. During the COVID-19 pandemic, procalcitonin testing was widely introduced at hospitals in the UK to guide antibiotic prescribing. We have determined the impact of this on hospital-level antibiotic consumption. Methods: We conducted a retrospective, controlled interrupted time series analysis of organization-level data describing antibiotic dispensing, hospital activity and procalcitonin testing for acute hospitals/hospital trusts in England and Wales during the first wave of COVID-19 (24 February to 5 July 2020). Results: In the main analysis of 105 hospitals in England, introduction of procalcitonin testing in emergency departments/acute medical admission units was associated with a statistically significant decrease in total antibiotic use of −1.08 (95% CI: −1.81 to −0.36) DDDs of antibiotic per admission per week per trust. This effect was then lost at a rate of 0.05 (95% CI: 0.02–0.08) DDDs per admission per week. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions rather than all admissions. Introduction of procalcitonin in the ICU setting was not associated with any significant change in antibiotic use. Conclusions: At hospitals where procalcitonin testing was introduced in emergency departments/acute medical units this was associated with an initial, but unsustained, reduction in antibiotic use. Further research should establish the patient-level impact of procalcitonin testing in this population and understand its potential for clinical effectiveness.