RESUMEN
BACKGROUND: Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK. OBJECTIVES: Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups. METHODS: Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020. RESULTS: Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22-0.64 days, Pâ<â0.001) and of 0.72 days (95% CI: 0.06-1.38 days, Pâ=â0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections. CONCLUSIONS: Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility. STUDY REGISTRATION NUMBER: ISRCTN66682918.
RESUMEN
The number of cases of group G streptococcal bacteraemia reported worldwide is increasing. Twenty-six cases of group G streptococcal bacteraemia were identified during a 70-month period at a single university teaching hospital in Sheffield, UK. These cases represented 20% of all bacteraemias due to beta-hemolytic Streptococci, a higher proportion than previously reported. The median age of these cases was 72 y and although medical comorbidities were common only cutaneous ulceration was clearly linked to the presenting syndromes. The skin was the source of infection in 16 cases (62%) and the most frequent clinical presentations were cellulitis in 13 cases (50%) and endovascular infection in 5 (19%). Eight (31%) of the cases died during the period of follow-up but only 2 deaths were related to the streptococcal infection. Immunosenescence represents the major risk factor for group G streptococcal infection in this population and comorbidities, including carcinoma, may be markers of the senescent immune system rather than direct contributing factors to group G streptococcal bacteraemia.
Asunto(s)
Envejecimiento/inmunología , Bacteriemia/epidemiología , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/microbiología , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/inmunología , Streptococcus/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Artritis Infecciosa/complicaciones , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Bacteriemia/tratamiento farmacológico , Bacteriemia/inmunología , Bacteriemia/microbiología , Celulitis (Flemón)/complicaciones , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/microbiología , Endocarditis/complicaciones , Endocarditis/tratamiento farmacológico , Endocarditis/microbiología , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/epidemiología , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Streptococcus/clasificación , Streptococcus/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/microbiología , Resultado del Tratamiento , Reino Unido/epidemiologíaRESUMEN
Streptococcus pneumoniae causes invasive disease world-wide and in all age groups. The reported incidence varies geographically and is increased in certain population groups. The incidence is highest in children less than 2 years and is also increased in the elderly. Mortality remains substantial even in the developed world despite appropriate antimicrobial therapy. The emergence of penicillin-resistant pneumococci highlights the importance of immunisation as a means to prevent disease. This review discusses the burden of invasive pneumococcal disease, identifies high-risk patients and analyses evidence for vaccine efficacy and cost-effectiveness.