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  • Diagnostic yield of bacteriological tests and predictors of severe outcome in adult patients with COVID-19 presenting to the emergency department

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Original research
Diagnostic yield of bacteriological tests and predictors of severe outcome in adult patients with COVID-19 presenting to the emergency department
  1. Anna Kaal1,
  2. Lars Snel1,
  3. Martijn Dane2,
  4. Nathalie van Burgel3,
  5. Thomas Ottens4,
  6. Winifred Broekman5,
  7. Lahssan el Bouazzaoui5,
  8. Nikki Kolfschoten6,
  9. Emile Schippers1,
  10. Ewout Steyerberg7,
  11. Soufian Meziyerh8,
  12. Cees van Nieuwkoop1
  1. 1 Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands
  2. 2 Clinical Chemistry, Haga Teaching Hospital, Den Haag, The Netherlands
  3. 3 Medical Microbiology, Haga Teaching Hospital, Den Haag, The Netherlands
  4. 4 Intensive Care, Haga Teaching Hospital, Den Haag, The Netherlands
  5. 5 Pulmonology, Haga Teaching Hospital, Den Haag, The Netherlands
  6. 6 Emergency Medicine, Haga Teaching Hospital, Den Haag, The Netherlands
  7. 7 Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
  8. 8 Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Anna Kaal, Internal Medicine, Haga Teaching Hospital, Den Haag, 2545 AA, The Netherlands; a.g.kaal{at}hagaziekenhuis.nl

Abstract

Background Guidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate the yield of bacteriological tests, including blood and sputum cultures, and the association of multiple biomarkers and the Pneumonia Severity Index (PSI) with clinical and microbiological outcomes in patients with COVID-19 presenting to the emergency department (ED).

Methods This is a substudy of a large observational cohort study (PredictED study). The PredictED included adult patients from whom a blood culture was drawn at the ED of Haga Teaching Hospital, The Netherlands. For this substudy, all patients who tested positive for SARS-CoV-2 by PCR in March and April 2020 were included. The primary outcome was the incidence of bacterial coinfection. We used logistic regression analysis for associations of procalcitonin, C reactive protein (CRP), ferritin, lymphocyte count and PSI score with a severe disease course, defined as intensive care unit admission and/or 30-day mortality. The area under the receiver operating characteristics curve (AUC) quantified the discriminatory performance.

Results We included 142 SARS-CoV-2 positive patients. On presentation, the median duration of symptoms was 8 days. 41 (29%) patients had a severe disease course and 24 (17%) died within 30 days. The incidence of bacterial coinfection was 2/142 (1.4%). None of the blood cultures showed pathogen growth while 6.3% was contaminated. The AUCs for predicting severe disease were 0.76 (95% CI 0.68 to 0.84), 0.70 (0.61 to 0.79), 0.62 (0.51 to 0.74), 0.62 (0.51 to 0.72) and 0.72 (0.63 to 0.81) for procalcitonin, CRP, ferritin, lymphocyte count and PSI score, respectively.

Conclusion Blood cultures appear to have limited value while procalcitonin and the PSI appear to be promising tools in helping physicians identify patients at risk for severe disease course in COVID-19 at presentation to the ED.

  • clinical assessment
  • COVID-19
  • diagnosis
  • emergency department
  • bacterial

Data availability statement

The deidentified participant data that support the findings of this study are available from the corresponding author, upon reasonable request. Email address: a.g.kaal@hagaziekenhuis.nl.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/emermed-2020-211027

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    Data availability statement

    The deidentified participant data that support the findings of this study are available from the corresponding author, upon reasonable request. Email address: a.g.kaal@hagaziekenhuis.nl.

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    Footnotes

    • Handling editor Roland C Merchant

    • Contributors AK, LS, SM and CvN contributed to the design of this research. Together with ESte they were responsible for the analysis. AK and LS wrote the draft of the article. CvN directed and supervised the project. All authors provided critical feedback, reviewed and revised the manuscript.

    • Funding This study was partly sponsored by an unrestricted grant (T18-040) of the Haga Scientific Research Fund.

    • Competing interests TO reports personal lecture fees from Gilead, outside the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.