Use of Procalcitonin during the First Wave of COVID-19 in the Acute NHS Hospitals: A Retrospective Observational Study
Neil Powell,
Philip Howard,
Martin J. Llewelyn,
Tamas Szakmany,
Mahableswhar Albur,
Stuart E Bond,
Joanne Euden,
Lucy Brookes-Howell,
Paul Dark,
Thomas P Hellyer,
Susan Hopkins,
Iain J McCullagh,
Margaret Ogden,
Philip Pallmann,
Helena Parsons,
David G Partridge,
Dominick E. Shaw,
Bethany Shinkins,
Stacy Todd,
Emma Thomas-Jones,
Robert West,
Enitan D Carrol,
Jonathan A. T. Sandoe
Affiliations
Neil Powell
Pharmacy Department, Royal Cornwall Hospital Trust, Truro TR1 3LJ, UK
Philip Howard
School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
Martin J. Llewelyn
Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PS, UK
Tamas Szakmany
Grange University Hospital, Aneurin Bevan University Health Board, Llanyravon, Cwmbran NP44 2XJ, UK
Mahableswhar Albur
North Bristol NHS Trust, Bristol BS10 5NB, UK
Stuart E Bond
Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
Joanne Euden
Centre for Trials Research, Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
Lucy Brookes-Howell
Centre for Trials Research, Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
Paul Dark
Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester M13 9PL, UK
Thomas P Hellyer
Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
Susan Hopkins
Public Health England, London SE1 8UG, UK
Iain J McCullagh
The Newcastle upon Tyne hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK
Margaret Ogden
Patient and Public Involvement Representative, NIHR, London SW1A 2NS, UK
Philip Pallmann
Centre for Trials Research, Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
Helena Parsons
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
David G Partridge
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
Dominick E. Shaw
Division of Respiratory Medicine, University of Nottingham, Nottingham NG7 2RD, UK
Bethany Shinkins
Test Evaluation Group, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
Stacy Todd
Liverpool University Hospital NHS Foundation Trust, Liverpool L9 7AL, UK
Emma Thomas-Jones
Centre for Trials Research, Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
Robert West
Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9TJ, UK
Enitan D Carrol
Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
Jonathan A. T. Sandoe
Healthcare Associated Infection Group, Leeds Institute of Medical Research, School of Medicine, University of Leeds, LS2 9JT, UK
A minority of patients presenting to hospital with COVID-19 have bacterial co-infection. Procalcitonin testing may help identify patients for whom antibiotics should be prescribed or withheld. This study describes the use of procalcitonin in English and Welsh hospitals during the first wave of the COVID-19 pandemic. A web-based survey of antimicrobial leads gathered data about the use of procalcitonin testing. Responses were received from 148/151 (98%) eligible hospitals. During the first wave of the COVID-19 pandemic, there was widespread introduction and expansion of PCT use in NHS hospitals. The number of hospitals using PCT in emergency/acute admissions rose from 17 (11%) to 74/146 (50.7%) and use in Intensive Care Units (ICU) increased from 70 (47.6%) to 124/147 (84.4%). This increase happened predominantly in March and April 2020, preceding NICE guidance. Approximately half of hospitals used PCT as a single test to guide decisions to discontinue antibiotics and half used repeated measurements. There was marked variation in the thresholds used for empiric antibiotic cessation and guidance about interpretation of values. Procalcitonin testing has been widely adopted in the NHS during the COVID-19 pandemic in an unevidenced, heterogeneous way and in conflict with relevant NICE guidance. Further research is needed urgently that assesses the impact of this change on antibiotic prescribing and patient safety.