Abstract
OBJECTIVE: To evaluate whether C reactive protein point-of-care testing (CRP POCT) safely reduces antibiotic prescribing for lower respiratory tract infections in nursing home residents.
DESIGN: Pragmatic, cluster randomised controlled trial.
SETTING: The UPCARE study included 11 nursing home organisations in the Netherlands.
PARTICIPANTS: 84 physicians from 11 nursing home organisations included 241 participants with suspected lower respiratory tract infections from September 2018 to the end of March 2020.
INTERVENTIONS: Nursing homes allocated to the intervention group had access to CRP POCT. The control group provided usual care without CRP POCT for patients with suspected lower respiratory tract infections.
MAIN OUTCOME MEASURES: The primary outcome measure was antibiotic prescribing at initial consultation. Secondary outcome measures were full recovery at three weeks, changes in antibiotic management and additional diagnostics during follow-up at one week and three weeks, and hospital admission and all cause mortality at any point (initial consultation, one week, or three weeks).
RESULTS: Antibiotics were prescribed at initial consultation for 84 (53.5%) patients in the intervention group and 65 (82.3%) in the control group. Patients in the intervention group had 4.93 higher odds (95% confidence interval 1.91 to 12.73) of not being prescribed antibiotics at initial consultation compared with the control group, irrespective of treating physician and baseline characteristics. The between group difference in antibiotic prescribing at any point from initial consultation to follow-up was 23.6%. Differences in secondary outcomes between the intervention and control groups were 4.4% in full recovery rates at three weeks (86.4% v 90.8%), 2.2% in all cause mortality rates (3.5% v 1.3%), and 0.7% in hospital admission rates (7.2% v 6.5%). The odds of full recovery at three weeks, and the odds of mortality and hospital admission at any point did not significantly differ between groups.
CONCLUSIONS: CRP POCT for suspected lower respiratory tract infection safely reduced antibiotic prescribing compared with usual care in nursing home residents. The findings suggest that implementing CRP POCT in nursing homes might contribute to reduced antibiotic use in this setting and help to combat antibiotic resistance.
TRIAL REGISTRATION: Netherlands Trial Register NL5054.
| Original language | English |
|---|---|
| Article number | n2198 |
| Pages (from-to) | 1-8 |
| Number of pages | 8 |
| Journal | BMJ (Clinical research ed.) |
| Volume | 374 |
| DOIs | |
| Publication status | Published - 21 Sept 2021 |
Funding
Contributors: JWMRT, LWvB, MWvT, TJMV, CMPMH, RMH, and TMB contributed to the statistical analysis plan. TMB performed the statistical analyses and drafted the manuscript. LWvB, CMPMH, TJMV, RMH, MWvT, and JWMRT contributed to the final version of the manuscript. All authors have read and approved the manuscript. TMB and LWvB accept responsibility for the overall content as guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Funding: The UPCARE study was funded by the Netherlands Organisation for Health Research and Development (ZonMw, program Antibiotic Resistance, grant No 541001 004). Orion Diagnostica and Saltro made in total 20 CRP POCT instruments available for the study. The funding bodies had no role in the design of the study, data collection, data analysis, interpretation, or in writing the manuscript or authority over any of these activities. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Netherlands Organisation for Health Research and Development, Orion Diagnostica and Saltro for the submitted work. LWvB reports a grant from the Netherlands Organisation for Health Research and Development (ZonMw) for the conduct of the current study. TMB, JWMRT, CMPMH, RMH and MWvT received no support from any organisation for the submitted work. TJMV reports grants from Abbott, Becton Dickinson, Biomerieux, European Commission, Orion during the conduct of the study, grants from European Commission, Janssen Pharmaceuticals, grants from ZonMw, outside the submitted work.
| Funders | Funder number |
|---|---|
| ZonMw | 541001 004 |
Keywords
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Antimicrobial Stewardship
- C-Reactive Protein/analysis
- Cluster Analysis
- Drug Prescriptions/statistics & numerical data
- Drug Resistance, Microbial
- Female
- Homes for the Aged
- Humans
- Male
- Netherlands
- Nursing Homes
- Point-of-Care Testing
- Respiratory Tract Infections/diagnosis
