PEACH [COVID-19]
Research type
Research Study
Full title
Procalcitonin: Evaluation of Antibiotics in COVID-19 Hospitalised patients.
IRAS ID
290358
Contact name
Jonathan Sandoe
Contact email
Sponsor organisation
University of Leeds
ISRCTN Number
ISRCTN66682918
Duration of Study in the UK
1 years, 1 months, 17 days
Research summary
Research Summary
Antibacterial agents (antibiotics) are usually used during treatment of patients with more severe COVID-19 even though COVID-19 is caused by a virus, and antibiotics don’t work against viruses. This is because doctors worry that there might be a bacterial infection on top of the viral infection, a so-called secondary infection, that is making matters worse. In fact, there is no good evidence to guide the use of antibiotics in COVID-19 and rates of secondary bacterial infection are thought to be low. The COVID-19 pandemic has therefore resulted in an unwanted increase in antibiotic use for these patients which will expose them to more side effects, an increased risk of infection with superbugs and increased costs. This is a study about a blood test called procalcitonin which is used in many hospitals to help diagnose bacterial infections and guide antibiotic treatment. There is a lack of clear evidence to support its use in lung infections, which means some hospitals have used the procalcitonin test to guide antibiotic decisions in COVID-19, whilst others have not.
The aim of the PEACH study is to assess whether the use of procalcitonin testing, to guide antibiotic prescribing, safely reduced antibiotic use among patients who were hospitalised with COVID-19 during the first wave of the pandemic. We will do this by gathering information on which hospitals did/did not/introduced procalitonin testing, looking at data from patients who had COVID-19 to see whether there were differences between those that had procalcitonin tests or not and conducting interviews with clinicians to understand decision processes involved in deciding whether to prescribe antibiotics to manage symptoms in patients with COVID-19.
Summary of results
Why did we do this study?
A blood test called procalcitonin (PCT) is used in hospitals to help diagnose bacterial infections and guide antibiotic treatment decisions. There is evidence to support its use in lung infections. During the COVID-19 pandemic some hospital clinicians used the PCT test to guide antibiotic prescribing decisions, whilst in other hospitals, they did not. This study looked at how the PCT test was used to help make those decisions and compared antibiotic prescribing and patient outcomes between hospitals that did or did not use the PCT test.What did we do?
We asked hospital pharmacists to complete a survey on antibiotic prescribing, conducted interviews with clinicians who worked during the pandemic, and collected and analysed data from patients’ clinical records from hospital Trusts that did and did not use PCT testing during the first wave of the COVID-19 pandemic. We showed how PCT testing was used, how staff made decisions on antibiotic prescribing and how PCT affected antibiotic use and patient outcomes.What did we find?
We found that PCT was not used consistently across the NHS. In hospitals that did use the test on patients with COVID-19, there was a statistically significant reduction in antibiotic prescribing, with no adverse effect on patient outcomes. We also found that antibiotic prescribing decisions for staff were influenced by many factors such as level of experience, confidence, support from other staff, and internal organisational factors. PCT testing was likely to be value for money.What does this mean?
PCT testing was shown to be a valid way to improve antibiotic use during the first wave of the pandemic. However, there remains a need for more adaptive, inclusive, wide-reaching clinical trials of tests that can diagnose infection. More implementation research is required before introduction into routine clinical practice.REC name
West Midlands - Solihull Research Ethics Committee
REC reference
21/WM/0052
Date of REC Opinion
3 Mar 2021
REC opinion
Further Information Favourable Opinion