• Lisa M Hessels, Esther Speksnijder, Nienke Paternotte, Astrid van Huisstede, Willemien Thijs, Margot Scheer, Mariëlle van der Steen-Dieperink, Lieve Knarren, Joop P van Den Bergh, Kristien Winckers, Ronald Henry, Suat Simsek, Wim G Boersma, and COVIDPredict Study Group.
• Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands. Electronic address: lm.hessels@nwz.nl.
• Chest. 2023 Sep 1; 164 (3): 596605596-605.

BackgroundDespite the low rate of bacterial coinfection, antibiotics are very commonly prescribed in hospitalized patients with COVID-19.Research QuestionDoes the use of a procalcitonin (PCT)-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection?Study Design And MethodsIn this multicenter cohort, three groups of patients with COVID-19 were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n = 216) and two control groups, consisting of patients from the same hospital (n = 57) and of patients from three similar hospitals (n = 486) without PCT measurements during the same period. The primary end point was antibiotic prescription in the first week of admission.ResultsAntibiotic prescription during the first 7 days was 26.8% in the PCT group, 43.9% in the non-PCT group in the same hospital, and 44.7% in the non-PCT group in other hospitals. Patients in the PCT group had lower odds of receiving antibiotics in the first 7 days of admission (OR, 0.33; 95% CI, 0.16-0.66 compared with the same hospital; OR, 0.42; 95% CI, 0.28-0.62 compared with the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was 35.2%, 43.9%, and 54.5%, respectively. The PCT group had lower odds of receiving antibiotics during the total admission only when compared with the other hospitals (OR, 0.23; 95% CI, 0.08-0.63). There were no significant differences in other secondary end points, except for readmission in the PCT group vs the other hospitals group.InterpretationPCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalized patients with COVID-19, without major safety concerns.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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