Critical Care Medicine Physician, New York, USA
Feeling unwell with cough and fatigue for one week. SARS-CoV-2 testing was positive.
Refractory diffuse large B-cell lymphoma, hypogammaglobulinemia, and recent treatment with Rituximab. Most recently developed progression on Rituximab-Gemcitabine- Oxaliplatin (R-GemOx) chemotherapy. He was in the process of CAR-T cell collection when a household member, developed COVID-19.
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 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. 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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