Academic Journal
Low prevalence of bacterial coinfection at hospital admission in COVID-19 and the role of procalcitonin as a rule-out biomarker.
| Τίτλος: | Low prevalence of bacterial coinfection at hospital admission in COVID-19 and the role of procalcitonin as a rule-out biomarker. |
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| Συγγραφείς: | Ena N; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain., García-Abellán J; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain; CIBERINFEC, ISCIII, Madrid, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain., Ledesma C; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain., Fernández-González M; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain; CIBERINFEC, ISCIII, Madrid, Spain., García-Sánchez L; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain., Padilla S; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain; CIBERINFEC, ISCIII, Madrid, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain., Masiá M; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain; CIBERINFEC, ISCIII, Madrid, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain. Electronic address: mmasia@umh.es., Gutiérrez F; Internal Medicine Service, Infectious Diseases Division, Hospital General Universitario de Elche, Alicante, Spain; Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain; CIBERINFEC, ISCIII, Madrid, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain. Electronic address: gutierrez_fel@umh.es. |
| Πηγή: | International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases [Int J Infect Dis] 2026 Sep; Vol. 170, pp. 108925. Date of Electronic Publication: 2026 Jun 25. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Canada NLM ID: 9610933 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-3511 (Electronic) Linking ISSN: 12019712 NLM ISO Abbreviation: Int J Infect Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: Hamilton, ON : Elsevier Original Publication: Hamilton, ON : Decker, c1996- |
| Ιατρικοί όροι (MeSH): | Procalcitonin*/blood , Coinfection*/epidemiology , Coinfection*/diagnosis , COVID-19*/complications , COVID-19*/epidemiology , COVID-19*/blood , COVID-19*/microbiology , Bacterial Infections*/epidemiology , Bacterial Infections*/diagnosis , Bacterial Infections*/blood, Biomarkers/blood ; Humans ; Female ; Male ; Prospective Studies ; Middle Aged ; Prevalence ; Aged ; Hospitalization ; SARS-CoV-2 |
| Περίληψη: | Background: Empirical antibiotic use at hospital admission is common in patients with COVID-19 despite uncertainty regarding the prevalence of bacterial coinfection. Procalcitonin (PCT) has been proposed to support early decision-making, but its diagnostic value at presentation remains unclear. Methods: We performed a post hoc analysis of a prospective cohort of adults hospitalized with SARS-CoV-2 infection between March 2020 and July 2022 who had PCT measured within 48 hours of admission. Bacterial coinfection at admission was investigated according to predefined institutional criteria. The diagnostic performance of PCT and other inflammatory biomarkers was assessed using microbiological confirmation as the reference standard. Clinical impact was evaluated using a composite outcome of intensive care unit admission, invasive mechanical ventilation, or 28-day mortality. Results: Among 2187 patients, bacterial coinfection was identified in 50 (2.3%). The respiratory tract was the most frequent source, and Streptococcus pneumoniae was the predominant pathogen. Patients with coinfection had higher inflammatory biomarker levels and worse outcomes, and coinfection was independently associated with the composite endpoint (adjusted odds ratio 4.31; 95% CI: 2.35-7.84). PCT showed the highest discriminative performance among evaluated biomarkers (AUC 0.79; 95% CI: 0.71-0.87). For PCT values <0.5 ng/mL, the negative predictive value was 99.1% (95% CI: 98.5-99.4), whereas other biomarkers showed lower discrimination despite similarly high negative predictive values. Conclusion: Bacterial coinfection at admission in COVID-19 is uncommon but associated with worse outcomes. PCT demonstrates good discrimination and a high rule-out value, supporting its use to guide early antibiotic decision-making in this low-prevalence setting. (Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. No funding or other support was received for the present study, and all declared financial relationships are unrelated to its content. S.P. has received lecture fees from ViiV and support for attending meetings from Janssen. J.G.A. has received lecture fees from ViiV and Janssen, and support for attending meetings from ViiV, Janssen, and Menarini. M.M. has received consulting fees and lecture fees from ViiV, Janssen, and MSD, and support for attending meetings from Janssen. F.G. has received consulting fees and lecture fees from ViiV, Janssen, and MSD; support for attending meetings from Janssen; and research grants from ViiV and Janssen. The remaining authors declare no conflicts of interest. |
| Contributed Indexing: | Keywords: Antibiotics; Bacterial coinfection; COVID-19; Microbiology; Procalcitonin; SARS-CoV-2 |
| Substance Nomenclature: | 0 (Procalcitonin) 0 (Biomarkers) |
| Entry Date(s): | Date Created: 20260625 Date Completed: 20260805 Latest Revision: 20260805 |
| Update Code: | 20260805 |
| DOI: | 10.1016/j.ijid.2026.108925 |
| PMID: | 42349772 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1878-3511 |
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| DOI: | 10.1016/j.ijid.2026.108925 |