C-reactive protein testing at the point-of-care in nursing homes: Towards more rational antibiotic prescribing for suspected lower respiratory tract infections

Lower respiratory tract infections in nursing home residents are difficult to diagnose due to atypical clinical presentation in the elderly population and limited diagnostic options in this setting. Given the potential severity of clinical outcome, antibiotics are often prescribed to be ‘better safe than sorry’. However, overprescribing of antibiotics may lead to the development of antimicrobial resistance, which decreases treatment possibilities for future infections. C-reactive protein point-of-care testing (CRP POCT) might contribute to more prudent antibiotic prescribing by reducing diagnostic uncertainty at initial consultation, and could therefore reinforce the global fight against antimicrobial resistance. This thesis presents the results of a cluster randomized controlled trial that was conducted in nursing homes across the Netherlands. We studied effectiveness and cost-effectiveness of CRP POCT-guided care to safely reduce antibiotic prescribing when compared with usual care. We also performed a process evaluation of CRP POCT implementation and use in the nursing home setting, and evaluated which clinical signs and symptoms related to CRP POCT-values.