
Periodicidad semestral: flujo continuo.
ISSN - Electrónico: 2661-6947 / DOI: 10.36015 • LILACS BIREME (19784); LATINDEX (20666)
INTRODUCTION. Procalcitonin is a biomarker that can be used as a diagnostic support in bacterial infections and the monitoring of antibiotic treatment, especially in patients with sepsis. Hence, it was used during the COVID-19 pandemic OBJECTIVE. To determine the values of procalcitonin in patients with COVID-19 and to define a possible correlation between its increase and linkage in co-infection or secondary infection by Klebsiella pneumoniae and Pseudomonas aeruginosa with multidrug resistance and extended resistance to antibiotics. MATERIALS AND METHODS. Retrospective observational, descriptive cross-sectional study, conducted from May 1 to October 31, 2020 at the Hospital de Especialidades Carlos Andrade Marín on 7028
adult patients, hospitalized, with diagnosis of COVID-19, and procalcitonin results, whose tracheal secretion and/or blood culture samples presented development of Klebsiella pneumoniae and Pseudomonas aeruginosa. Their statistical analysis was developed using Pearson’s Chi-squared test. RESULTS. We received 861 blood culture and 391 tracheal secretion samples, obtaining: 32% isolates of Klebsiella pneumoniae and multidrug-resistant and extremely resistant Pseudomonas aeruginosa.
Among the COVID-19 patients who died, 34.4% showed increased procalcitonin levels. On the contrary, among patients who survived, only 8.8% showed increased procalcitonin levels, showing a link between increased procalcitonin levels and mortality. CONCLUSIONS. There is no difference in relation to the increase in procalcitonin values in COVID-19 patients with co-infection or secondary infection by Klebsiella
pneumoniae and multidrug-resistant and extremely resistant Pseudomonas aeruginosa and procalcitonin values in patients with co-infection and secondary infection with other types of bacterial isolates.
EFERENCIAS BIBLIOGRAFICAS
Ahmed S, Jafri L, Hoodbhoy Z, Siddiqui I. Prognostic value of serum procalcitonin in covid-19 patients: A systematic review. Indian J Crit Care Med [Internet]. 2021;25(1):77–84. Available from:
https://www.ijccm.org/doi/pdf/10.5005/jp-journals-10071-23706
Kumar A, Karn E, Trivedi K, Kumar P, Chauhan G, Kumari A, et al. Procalcitonin as a predictive marker in COVID-19: A systematic review and meta-analysis. PLoS One [Internet]. 2022;17(9 9):1–22. Available from: http://dx.doi.org/10.1371/journal.pone.0272840
Moretti M, Van Laethem J, Minini A, Pierard D, Malbrain MLNG. Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother [Internet]. 2021;27(6):826–33. Available from:
https://doi.org/10.1016/j.jiac.2021.01.011
Martono, Fatmawati F, Mulyanti S. Risk Factors Associated with the Severity of COVID-19. Malaysian J Med Sci
[Internet]. 2023;30(3):84–92. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10325129/
Kaçmaz B, Keske Ş, Sişman U, Ateş ST, Güldan M, Beşli Y, et al. COVID-19 associated bacterial infections in intensive care unit: a case control study. Sci Rep [Internet]. 2023;13(1):1–7. DOI: https://doi.org/10.1038/s41598-023-39632-2. Available from:
https://www.nature.com/articles/s41598-023-39632-2
Scott H, Zahra A, Fernandes R, Fries BC, Thode HC, Singer AJ. Bacterial infections and death among patients with Covid-19 versus non Covid-19 patients with pneumonia. Am J Emerg Med [Internet]. 2022;51(January):1–5. Available from:
https://pubmed.ncbi.nlm.nih.gov/34637995/
Chang R, Elhusseiny KM, Yeh YC, Sun WZ. COVID-19 ICU and mechanical ventilation patient characteristics
and outcomes—A systematic review and meta-analysis. PLoS One [Internet]. 2021;16(2 February):1–16. DOI:
http://dx.doi.org/10.1371/journal.pone.0246318. Available from:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246318
Paudel R, Dogra P, Montgomery-Yates AA, Yataco AC. Procalcitonin: A promising tool or just another overhyped test? Int J Med Sci [Internet]. 2020;17(3):332–7. Available from:
https://medsci.org/v17p0332.pdf
Gregoriano C, Heilmann E, Molitor A, Schuetz P. Role of procalcitonin use in the management of sepsis. J Thorac Dis [Internet]. 2020;2(Suppl 1):S5–15. Available from: https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC7024752/
Nag VL, Kaur N. Superinfections in COVID-19 Patients: Role of Antimicrobials. Dubai Med J [Internet].
;4(2):117–26. Available from:
https://karger.com/dmj/article-pdf/4/2/117/2624007/000515067.pdf
Azzini AM, Dorizzi RM, Sette P, Vecchi M, Coledan I, Righi E, et al. A 2020 review on the role of procalcitonin
in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine. Ann Transl Med [Internet]. 2020;8(9):610–610. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290560/
Wolfisberg S, Gregoriano C, Schuetz P. Procalcitonin for individualizing antibiotic treatment: an update with
a focus on COVID-19. Crit Rev Clin Lab Sci [Internet]. 2022;59(1):54–65. DOI: https://doi.org/10.1080/1040836
2021.1975637. Available from:
https://www.tandfonline.com/doi/full/10.1080/10408363.2021.1975637
Schuetz P. How to best use procalcitonin to diagnose infections and manage antibiotic treatment. Clin Chem Lab Med [Internet]. 2023;61(5):822–8. Available from:
https://pubmed.ncbi.nlm.nih.gov/36317790/
Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect [Internet]. 2020;26(12):1622–9. DOI: https://doi.org/10.1016/j.cmi.2020.07.016. Available from:
https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30423-7/fulltext
Pozo JLD. Respiratory co-and superinfections in covid-19. Rev Esp Quimioter [Internet]. 2021;34:69–71. DOI:
http://www.doi.org/10.37201/req/s01.20.2021. Available from:
https://pubmed.ncbi.nlm.nih.gov/34598432/
Montrucchio G, Corcione S, Sales G, Curtoni A, De Rosa FG, Brazzi L. Carbapenem-resistant Kleb-
siella pneumoniae in ICU-admitted COVID-19 patients: Keep an eye on the ball. J Glob Antimicrob Resist [In-
ternet]. 2020;23:398–400. DOI: https://doi.org/10.1016/j.jgar.2020.11.004. Available from:
https://www.sciencedirect.com/science/article/pii/S2213716520302927?via%-3Dihub
Westblade LF, Simon MS, Satlin MJ. Bacterial Coinfections in Coronavirus Disease 2019. Trends Micro-
biol [Internet]. 2021;29(10):930–41. DOI: https://doi.org/10.1016/j.tim.2021.03.018. Available fromo:
https://doi.org/10.1016/j.tim.2021.03.018
Al-Hadidi SH, Alhussain H, Abdel Hadi H, Johar A, Yassine HM, Al Thani AA, et al. The Spectrum of Anti-
biotic Prescribing during COVID-19 Pandemic: A Systematic Literature Review. Microb Drug Resist [Internet].
;27(12):1705–25. DOI: https://www.liebertpub.com/doi/pdf/10.1089/mdr.2020.0619. Available from:
https://www.liebertpub.com/doi/pdf/10.1089/mdr.2020.0619
Mohsen S, Dickinson JA, Somayaji R. Update on the adverse effects of antimicrobial therapies in community
practice. Can Fam Physician [Internet]. 2020;66(9):651–9. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491661/
Malcolm W, Seaton RA, Haddock G, Baxter L, Thirlwell S, Russell P, et al. Impact of the COVID-19 pandemic on
community antibiotic prescribing in Scotland. JAC-Antimicrobial Resist [Internet]. 2021;2(4):1–4. DOI: https://
doi.org/10.1093/jacamr/dlaa105. Available from:
https://academic.oup.com/jacamr/article/2/4/dlaa105/6027206
Zhang A, Hobman E V., De Barro P, Young A, Carter DJ, Byrne M. Self-medication with antibiotics for protection against COVID-19: The role of psychological distress, knowledge of, and experiences with antibiotics. Antibiotics [Internet]. 2021;10(3):1–14. Available from:
https://pubmed.ncbi.nlm.nih.gov/33668953/
Jiménez Pearson MA, Galas M, Corso A, Hormazábal JC, Duarte Valderrama C, Salgado Marcano N, et
al. Consenso latinoamericano para definir, categorizar y notificar patógenos multirresistentes, con resistencia ex
tendida o panresistentes. Rev Panam Salud Pública [Internet]. 2019;1–8. Available from:
https://iris.paho.org/handle/10665.2/51470
Jabłońska-Trypuć A, Makuła M, Włodarczyk-Makuła M, Wołejko E, Wydro U, Serra-Majem L, et al. Inanimate
Surfaces as a Source of Hospital Infections Caused by Fungi, Bacteria and Viruses with Particular Emphasis on
SARS-CoV-2. Int J Environ Res Public Health [Internet]. 2022;19(13). Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9265696/
Feng T, James A, Doumlele K, White S, Twardzik W, Zahid K, et al. Procalcitonin Levels in COVID-19 Pa
tients Are Strongly Associated with Mortality and ICU Acceptance in an Underserved , Inner City Population.
;(March 2020):1–11. Available from:
https://www. ncbi.nlm.nih.gov/pmc/articles/PMC8539303/#:~:text=- Conclusions%3A Procalcitonin showed the greatest,severity during COVID-19 infection.
Rivera-Fernandez R, Yáguez-Mateos L, Guerrero-Marin M, Pérez-Manrique RM, Rojas-Amezcua M, Pontes-Moreno AJ, et al. Evaluation of procalcitonin elevation during ICU stay and its relationship with mortality in ICU patients for COVID-19 with respiratory involvement. A multicenter prospective cohort study. Front Med [Internet]. 2022;9(December):1–14. Available from:
https://www.frontiersin.org/articles/10.3389/fmed.2022.972659/full
Nandi A, Pecetta S, Bloom DE. Global antibiotic use during the COVID-19 pandemic: analysis of pharmaceu-
tical sales data from 71 countries, 2020–2022. eClinical Medicine [Internet]. 2023;57:101848. DOI: https://doi.or-
g/10.1016/j.eclinm.2023.101848. Available from:
https://www.thelancet.com/journals/eclinm/article/PIIS25895370(23)00025-1/fulltext
Dueñas-Castell C, Polanco-Guerra CJ, Martinez-Ávila MC, Almanza Hurtado AJ, Rodriguez Yanez T, Gutie-
rrez-Ariza JC, et al. When to Use Antibiotics in COVID-19: A Proposal Based on Questions. Cureus [Internet].
;14(7):1–9. Available from:
https://assets.cureus.com/uploads/review_article/pdf/106827/20220827-24749-1xs1eel.pdf
Tiri B, Sensi E, Marsiliani V, Cantarini M, Priante G, Vernelli C, et al. Antimicrobial stewardship program, COVID-19, and infection control: Spread of carbapenem-resistant Klebsiella pneumoniae colonization in ICU COVID-19 patients. What did not work? J Clin Med [Internet]. 2020;9(9):1–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563368/
Stefanini I, De Renzi G, Foddai E, Cordani E, Mognetti B. Profile of bacterial infections in covid-19 patients: Antimicrobial resistance in the time of SARS-CoV-2. Biology (Basel) [Internet]. 2021;10(9). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467430/
Beatriz PA, Alberto MJ, Enrique MN, Guillermo RJ. El sexo como factor de riesgo de la mortalidad por COVID-19. Caso Ecuador Sex as a risk factor for COVID-19 mortality . Ecuador case. Portal Rev Científicas y Humanísticas
la Univ del Zulia, Venez [Internet]. 2021;49(2):1–10. Available from: https://produccioncientificaluz.org/index.php/kasmera/article/view/35672/39277
Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Lumbreras-Bermejo C, Ramos-Rincón JM, Roy-Vallejo
E, et al. Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19
Registry. Rev Clin Esp [Internet]. 2020 Nov 1;220(8):480–94. Available from: https://www.sciencedirect.com/science/article/pii/S001425652030206X?via%3Dihub
Fabião J, Sassi B, Pedrollo EF, Gerchman F, Kramer CK, Leitão CB, et al. Why do men have worse COVID-19-re-
lated outcomes ? A systematic review and meta-analysis with sex adjusted for age. Brazilian J Med Biol Res [In-
ternet]. 2022;1–8. Available from:
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