The University of Toledo Translation Journal of Medical Sciences 
Infectious Diseases Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e2 

Early Infectious Diseases Consultation and 
Procalcitonin-Guided Therapy Limits 
Unnecessary Antibiotic Use in COVID-19 
Joel A. Kammeyer, MD, MPH1*, Meghan M. Deutsch1, Victoria R. Starnes1, Makoto Ibaraki, MPH1, Victoria 
Soewarna1, Basmah Khalil, MD1, Katherine K. Girdhar, MPH1, Riaz Fabian, DO1, Justin Franco1, Stephanie 
Staten, APRN-CNP1, Julia Berry1, Abhishiek Setia, MD1, Kada Williams1, Rebecca Asher1, Kylie Rostad1, 
Caitlyn M. Hollingshead, MD1 
1Division of Infectious Diseases, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: joel.kammeyer@utoledo.edu

Published: 05 May 2023 

Background: Antibiotic stewardship has been a central challenge of the COVID-19 pandemic. Empiric 
antibiotic therapy is offered in 56.6%-74.6% of inpatients with COVID-19, with microbiologically 
confirmed bacterial pneumonia reported in only 3.5%-16% of cases. Procalcitonin (PCT) as a biomarker 
for bacterial infection is of interest in improving antibiotic use. PCT-guided antibiotic stewardship 
initiatives have demonstrated reduction in the use of antibiotics in the COVID-19 pandemic. An 
Infectious Diseases (ID) consultation was obtained on most patients at our institution throughout the 
COVID-19 pandemic. We report a significant reduction in antibiotic use among COVID-19 patients in 
the setting of near-universal ID consultation in COVID-19 patients. 

Methods: We evaluated the records of 1346 patients with COVID-19 from March 2020 – May 2021 at 
four hospitals with ID consultant availability. We assessed the inclusion of an ID consultant, antibiotic 
indication, initiation and discontinuation, PCT levels, radiologic images, and changes to therapy 
decisions. A chi-square test of independence and simple logistic regression were conducted to determine 
whether an association exists between the PCT level and the decision to discontinue antibiotics. 

Results: Of 1346 patients with a confirmed COVID-19 diagnosis, 64.6% (870/1346) received antibiotics 
on admission. The most common diagnosis associated with initial antibiotic administration was bacterial 
pneumonia (692/870, 79.5%).  An ID consultation was obtained on 97.8% (677/692) of the patients that 
received antibiotics for suspected bacterial pneumonia. In 48.1% (326/677) of these patients, antibiotics 
were discontinued within the first 48 hours of the ID consultation. A statistically significant difference 
was noted between the PCT level and continuation of antibiotics (Χ2= 67.02, p < .01). The odds of 
discontinuing antibiotics for the upper (PCT > 0.51) and middle (PCT = 0.26-0.50) groups were 0.22 
and 0.37, respectively, when compared to the lower (PCT ≤ 0.25) group. 

https://dx.doi.org/10.46570/utjms.vol11-2023-757 

https://dx.doi.org/10.46570/utjms.vol11-2023-757
mailto:joel.kammeyer@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-757 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-757 2 ©2023 UTJMS 

Conclusion: Early consultation of an ID specialist and evaluation of PCT levels leads to significant 
reductions in inappropriate antibiotic use. PCT may be a useful adjunct in assisting with the decision to 
discontinue antibiotics. 

https://dx.doi.org/10.46570/utjms.vol11-2023-757
https://dx.doi.org/10.46570/utjms.vol11-2023-757