Usefulness of repeated procalcitonin measurements in the management of severe SARS-CoV-2 pneumonia

Bacterial respiratory co-infection and secondary superinfection are complications of severe acute respiratory coronavirus 2 (SARS-CoV2) pneumonia. Despite the relative low incidence rate of bacterial coinfection, most patients receive empirical antibiotic therapy on ICU admission. To help antibiotic prescribing, we evaluated the effectiveness of repeated PCT measurements in predicting bacterial co-infection and superinfection. This was an ancillary study of the MultiCoV study. All adult patients admitted to one of 13 participating ICUs with PCR-confirmed severe SARS-CoV2 pneumonia and a PCT measurement upon admission were included. The primary endpoint was the performance of the admission PCT level in diagnosing bacterial co-infection. Of the 182 patients included in the study, bacterial co-infection was diagnosed in 62 (34%) of them. The median admission PCT level was 0.3 ng/mL [0.11; 1.56] versus 0.25 ng/mL [0.11; 0.59] in the groups of patients with and without bacterial co-infection respectively. Admission PCT level greater or equal than 1.50 ng/mL was associated with bacterial co-infection (OR 2.43, 95% CI [1.11; 5.34]; p = 0.026). Moreover, median PCT levels at day 3 were higher in the superinfection group (0.31 ng/mL [0.12; 1.36] versus 0.14 ng/mL [0.10; 0.44]) and in the group of patients who died at day 28 (> 1 ng/mL in 16.3% versus 8.6%). Daily PCT measurements for patients with severe SARS-CoV2 pneumonia could help in antibiotic prescribing in the first days of ICU admission.