PEACH

Procalcitonin: Evaluation of Antibiotic use in COVID-19 Hospitalised patients.

Opt out statement

Data will be collected retrospectively from patients admitted to hospital with Covid between March and July 2020.The purpose of the study is to determine if the use of Procalcitonin can help clinicians to prescribe antibiotics more judiciously in the use of antibiotics in hospitalised adult patients with Covid-19. As the research is retrospective, and funded and commissioned by DHSC to inform future waves in the pandemic, patient data are accessed without consent. Patients have the option to find out about this use of their data and to express an objection if they so wish by contacting peach@cardiff.ac.uk.

Background

Antibacterial agents (antibiotics) have been used during treatment of patients with more severe COVID-19, despite the fact that COVID-19 is caused by a virus, and antibiotics don’t work against viruses. This is because doctors are concerned 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 which will expose patients to more side effects, an increased risk of infection with superbugs and increase healthcare cost.

Guiding antibiotic decisions

PEACH about a blood test called procalcitonin (PCT) 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 in some hospitals, clinicians have used the procalcitonin test to guide antibiotic decisions in COVID-19, whilst in other hospitals, they have not. The PEACH study will analyse data from hospitals that did and did not use procalcitonin testing during the first wave of the COVID-19 pandemic. It will determine whether and how procalcitonin testing should be used in the NHS in future waves of COVID-19 to protect patients from antibiotic overuse.

Research aim

To assess whether the use of PCT testing, to guide antibiotic prescribing, safely reduced antibiotic use among patients who were hospitalised with COVID-19 during the first wave of the pandemic.

Study design

We will answer this question through three different, and complimentary, work streams (WS). Each WS will contain discrete work packages (WP):

• WS 1: Utilization of PCT testing to guide antibiotic prescribing during the first wave of COVID-19 pandemic.
• WS 2: Patient-level impact of PCT testing on antibiotic exposure and clinical outcome. (Main Work Stream)
• WS 3: Health economics analysis of PCT testing to guide antibiotics in COVID-19.

Public and patient involvement

We have developed this study with input from people who survived intensive care, including COVID-19. Our public and patient involvement (PPI) panel will lead on engagement with patient groups and the wider public through involvement with ICUsteps, Antibiotic Action and Antibiotic Research UK.