PROCALCITONIN AS ANTIMICROBIAL MANAGEMENT TOOL IN COVID-19 PATIENTS

Lenardt, Maria Helena; Cechinel, Clovis; Rodrigues, João Alberto Martins; Binotto, Maria Angélica; Zanata, Isabel de Lima; Kraus, Rosane; Marques, Daiane Maria da Silva

doi:10.1590/ce.v28i0.89833

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Sumário

ORIGINAL ARTICLE • Cogitare Enferm. 28 • 2023 • https://doi.org/10.1590/ce.v28i0.89833 copy

PROCALCITONIN AS ANTIMICROBIAL MANAGEMENT TOOL IN COVID-19 PATIENTS

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

The procalcitonin-guided therapy in COVID-19 reduces antimicrobial use.
The procalcitonin serum levels showed an association with mortality.
There was a relationship between the PCT serum levels and laboratory markers related to bacterial infection.

ABSTRACT

Objective:

to investigate the relationship between procalcitonin in the differential diagnosis of bacterial coinfection in COVID-19 patients.

Method:

a cross-sectional retrospective study conducted between February and March 2021 in the Intensive Care Unit of a public hospital from southern Brazil by filling in a form. Descriptive statistical analyses were performed, as well as of association between variables.

Results:

of the 231 patients, 28.14% presented infection (63.20% in the lungs), 25% had bacteria isolated, 77.49% used antimicrobials and, in 14.72% of the cases, procalcitonin > 2 ng/mL. There was a significant association between antimicrobial use and infection (p=0.001), isolation of bacteria (p<0.001), topography of the infection (p<0.001) and procalcitonin values (p<0.001). Procalcitonin use showed an association with bacterial infection (p<0.001), isolation of bacteria (p<0.001), antimicrobial use (p=0.001) and death (p<0.001).

Conclusion:

procalcitonin can reduce empirical antimicrobial use and stimulate detection and identification of pathogens, taking into account the clinical and epidemiological data.

DESCRIPTORS:
Antimicrobial Management; COVID-19; Procalcitonin; In-hospital Infection Control Services; Intensive Care Unit.

Variable		n^† † n = Number of patients in the subgroup; ‡CI = Confidence Interval;	%	CI^‡ (95%)
Gender	Female	105	45.45	39.16	51.9
Gender	Male	126	54.55	48.1	60.84
Outcome	Not death	72	31.17	25.54	37.41
Outcome	Death	159	68.83	62.59	74.46
Healthcare-Associated Infection	No	166	71.86	65.74	77.27
Healthcare-Associated Infection	Yes	65	28.14	22.73	34.26
Confirmed infection by ANVISA^§ § ANVISA = Agência Nacional de Vigilância Sanitária (National Health Surveillance Agency). criteria	No	136	58.87	52.43	65.02
	Yes	95	41.13	34.98	47.57
Topography	Bloodstream infection	7	3.03	1.48	6.12
	Unidentified infection site	69	29.87	24.34	36.06
	Skin - Soft parts	1	0.43	0.076	2.41
	Pulmonary	146	63.20	56.82	69.16
	Urine	8	3.46	1.77	6.68
Isolated bacterium	No	173	74.89	68.92	80.05
Isolated bacterium	Yes	58	25.11	19.95	31.08
Antibiotic use	No	52	22.51	17.6	28.32
Antibiotic use	Yes	179	77.49	71.68	82.4
Procalcitonin	Normal	136	58.87	52.43	65.02
	Viral infection	61	26.41	21.14	32.44
	Probability of bacterial coinfection	34	14.72	10.73	19.86

Variables	Covariates	Antibiotics						p-value
		Did not use		Used and suspended		Used and did not suspend
		n^† † n = Number of patients in the subgroup; ‡%row = Value in each row as a percentage of the row total;	%row^‡	n^† † n = Number of patients in the subgroup; ‡%row = Value in each row as a percentage of the row total;	%ro^w‡	n^† † n = Number of patients in the subgroup; ‡%row = Value in each row as a percentage of the row total;	%row^‡
Gender	Female	27	25.7	30	28.6	48	45.7	0.363
Gender	Male	25	19.8	46	36.5	55	43.7	0.363
Outcome	Not death	17	23.6	30	41.7	25	34.7	0.091
Outcome	Death	35	22	46	28.9	78	49.1	0.091
HAI^§ § HAI = Healthcare-Associated Infection;	No	48	28.9	63	38	55	33.1	<0.001
HAI^§ § HAI = Healthcare-Associated Infection;	Yes	4	6.2	13	20	48	73.8	<0.001
IC^†† †† IC = Infection confirmed by ANVISA criteria;	No	39	28.7	28	20.6	69	50.7	<0.001
IC^†† †† IC = Infection confirmed by ANVISA criteria;	Yes	13	13.7	48	50.5	34	35.8	<0.001
Topography	Bloodstream infection	0	0	2	28.6	5	71.4	<0.001
	No	33	47.8	14	20.3	22	31.9
	Skin - Soft parts	0	0	1	100	0	0
	Pulmonary	19	13	59	40.4	68	46.6
	Urine	0	0	0	0	8	100
Isolated bacterium	No	48	27.7	65	37.6	60	34.7	<0.001
Isolated bacterium	Yes	4	6.9	11	19	43	74.1	<0.001
PCT^‡‡ ‡‡ PCT = Serum procalcitonin.	Normal	41	30.1	53	39	42	30.9	<0.001
	Viral infection	10	16.4	14	23	37	60.7
	Probability of bacterial coinfection	1	2.9	9	26.5	24	70.6

	A (PCT^† † PCT = Serum Procalcitonin; < 0.5 ng/mL)				B (PCT^† † PCT = Serum Procalcitonin; from 0.5 to 2 ng/mL)				C (PCT^† † PCT = Serum Procalcitonin; > 2 ng/mL)
Variable	M^‡ ‡ M = Mean;	MD^§ § MD = Median;	SD^†† †† SD = Standard Deviation;	IQR^‡‡ ‡‡ IQR = Interquartile Range;	M^‡ ‡ M = Mean;	MD^§ § MD = Median;	SD^†† †† SD = Standard Deviation;	IQR^‡‡ ‡‡ IQR = Interquartile Range;	M^‡ ‡ M = Mean;	MD^§ § MD = Median;	SD^†† †† SD = Standard Deviation;	IQR^‡‡ ‡‡ IQR = Interquartile Range;
Total leukocytes	12,405	11,395	5,224	6,925	16,478	16,590	7,787	8,810	16,761	15,520	8,609	11,195
Neutrophils	10,884	10,029	4,714	6,115	14,775	14,988	6,643	8,112	14,396	12,400	8,128	9,507
Band cells	799	635	715	666	1,648	1,207	1,822	1,599	1,927	1,457	1,629	2,656
CRP^§§ §§ CRP = C-Reactive Protein.	130	122	98	105	169	158	92	128	192	165	127	211

Variables/Covariates n^‡ ‡ n = Number of patients in the subgroup;		A (PCT^† † PCT = Serum procalcitonin; < 0.5 ng/mL)				B (PCT^† † PCT = Serum procalcitonin; from 0.5 to 2 ng/mL)				C (PCT^† † PCT = Serum procalcitonin; > 2 ng/mL)
		%row^§ § %row = Value in each row as a percentage of the row total;	%col^†† †† %col = Percentages in the columns, that is, adding up to 100% in the column category;	%total	n^‡ ‡ n = Number of patients in the subgroup;	%row^§ § %row = Value in each row as a percentage of the row total;	%col^†† †† %col = Percentages in the columns, that is, adding up to 100% in the column category;	%total	n^‡ ‡ n = Number of patients in the subgroup;	%row^§ § %row = Value in each row as a percentage of the row total;	%col^†† †† %col = Percentages in the columns, that is, adding up to 100% in the column category;	%total	p-value
Gender	Female	63	60	46.3	27.3	26	24.8	42.6	11.3	16	15.2	47.1	6.9	0.871
Gender	Male	73	57.9	53.7	31.6	35	27.8	57.4	15.2	18	14.3	52.9	7.8	0.871
Outcome	Not death	56	77.8	41.2	24.2	12	16.7	19.7	5.2	4	5.6	11.8	1.7	<0.001
Outcome	Death	80	50.3	58.8	34.6	49	30.8	80.3	21.2	30	18.9	88.2	13	<0.001
HAI^‡‡ ‡‡ HAI = Healthcare-Associated Infection;	No	110	66.3	80.9	47.6	34	20.5	55.7	14.7	22	13.3	64.7	9.5	<0.001
HAI^‡‡ ‡‡ HAI = Healthcare-Associated Infection;	Yes	26	40	19.1	11.3	27	41.5	44.3	11.7	12	18.5	35.3	5.2	<0.001
IC^§§ §§ IC = Infection confirmed by ANVISA criteria.	No	81	59.6	59.6	35.1	38	27.9	62.3	16.5	17	12.5	50	7.4	0.49
IC^§§ §§ IC = Infection confirmed by ANVISA criteria.	Yes	55	57.9	40.4	23.8	23	24.2	37.7	10	17	17.9	50	7.4	0.49
Topography	Bloodstream infection	2	28.6	1.5	0.9	3	42.9	4.9	1.3	2	28.6	5.9	0.9	0.036
	No	52	75.4	38.2	22.5	13	18.8	21.3	5.6	4	5.8	11.8	1.7
	Skin - Soft parts	1	100	0.7	0.4	0	0	0	0	0	0	0	0
	Pulmonary	78	53.4	57.4	33.8	41	28.1	67.2	17.7	27	18.5	79.4	11.7
	Urine	3	37.5	2.2	1.3	4	50	6.6	1.7	1	12.5	2.9	0.4
Isolated bacterium	No	114	65.9	83.8	49.4	38	22	62.3	16.5	21	12.1	61.8	9.1	<0.001
Isolated bacterium	Yes	22	37.9	16.2	9.5	23	39.7	37.7	10	13	22.4	38.2	5.6	<0.001
Antibiotic use	No	41	78.8	30.1	17.7	10	19.2	16.4	4.3	1	1.9	2.9	0.4	<0.001
Antibiotic use	Yes	95	53.1	69.9	41.1	51	28.5	83.6	22.1	33	18.4	97.1	14.3	<0.001

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[1] Role of Authors:

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work - Lenardt MH, Cechinel C, Rodrigues JAM, Binotto MA, Zanata I de L, Kraus R, Marques DM da S; Drafting the work or revising it critically for important intellectual content - Lenardt MH, Cechinel C, Rodrigues JAM, Binotto MA, Zanata I de L, Kraus R, Marques DM da S; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved - Lenardt MH, Cechinel C, Rodrigues JAM, Binotto MA, Zanata I de L, Kraus R, Marques DM da S. All authors approved the final version of the text.