Case Study

COVID-19 Positive Rule-out Bacterial Pneumonia


Critical Care Medicine Physician
New York, USA



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Key Takeaways

Takeaway #1

Takeaway #1

Bacterial co-infection and secondary bacterial infections are relatively infrequent (< 10%) in hospitalized patients with COVID-19, yet over 70% of patients receive antibiotics on hospital admission and often for several days.1



Takeaway #2

Takeaway #2

Majority of these patients may not require empiric IV antibiotics. Procalcitonin has a high negative-predictive value at ≤ 0.25 μg/L for determining need for antibiotics in patients with community-acquired pneumonia, including those who have underlying malignancy.



Takeaway #3

Takeaway #3

PCT levels also have a high negative predictive value when compared to blood cultures.2,3 Serial PCTs can assist with confirming the initial negative result and indicate that antibiotics are no longer necessary.



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References
  1. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, Soucy JR, Daneman N. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020 Dec;26(12):1622-1629. doi: 10.1016/j.cmi.2020.07.016. Epub 2020 Jul 22. PMID: 32711058.
  2. Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol. 2011 Feb;135(2):182-9.
  3. Oussalah A, Ferrand J, Filhine-Tresarrieu P, Aissa N, Aimone-Gastin I, Namour F, et al. Diagnostic accuracy of procalcitonin for predicting blood culture results in patients with suspected bloodstream infection: an observational study of 35,343 consecutive patients (A STROBE-Compliant Article). Medicine (Baltimore). 2015 Nov;94(44):e1774.