当前位置: X-MOL 学术BMJ › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: cluster randomised controlled trial
The BMJ ( IF 105.7 ) Pub Date : 2021-09-21 , DOI: 10.1136/bmj.n2198
Tjarda M Boere 1 , Laura W van Buul 2 , Rogier M Hopstaken 3, 4, 5 , Maurits W van Tulder 6 , Jos W M R Twisk 7 , Theo J M Verheij 8, 9 , Cees M P M Hertogh 1, 8
Affiliation  

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 The datasets generated and analysed during the current study will be deposited in the repository DANS (EASY) after publication of the research results, within a maximum of nine months after the end of the study. The datasets involved will be pseudonymised and can be accessed under restrictions.

中文翻译:

C反应蛋白即时检测对疗养院居民下呼吸道感染抗生素处方的影响:整群随机对照试验

目的 评估 C 反应蛋白即时检测 (CRP POCT) 是否可以安全地减少疗养院居民下呼吸道感染的抗生素处方。设计务实的整群随机对照试验。设置 UPCARE 研究包括荷兰的 11 个疗养院组织。参与者 2018 年 9 月至 2020 年 3 月底,来自 11 个疗养院组织的 84 名医生包括 241 名疑似下呼吸道感染的参与者。对照组为疑似下呼吸道感染的患者提供常规护理,不进行 CRP POCT。主要结局指标 主要结局指标是初次咨询时的抗生素处方。次要结果指标是三周时的完全康复、抗生素管理的变化和一周和三周随访期间的额外诊断,以及住院和任何时间点的全因死亡率(初始咨询、一周或三周)。结果 干预组 84 例 (53.5%) 患者和对照组 65 例 (82.3%) 患者在初次咨询时开具抗生素处方。与对照组相比,无论治疗医生和基线特征如何,干预组患者在初次咨询时未开具抗生素处方的几率高 4.93(95% 置信区间为 1.91 至 12.73)。从初次咨询到随访的任何时间点抗生素处方的组间差异为 23.6%。干预组和对照组之间次要结局的差异为三周完全康复率 4.4%(86.4% 对 90.8%)、全因死亡率 2.2%(3.5% 对 1.3%)和住院率 0.7% (7.2% 对 6.5%)。三周时完全康复的几率,以及任何时间点的死亡率和入院几率在各组之间没有显着差异。结论 与疗养院居民的常规护理相比,针对疑似下呼吸道感染的 CRP POCT 安全地减少了抗生素处方。研究结果表明,在疗养院实施 CRP POCT 可能有助于减少这种情况下的抗生素使用,并有助于对抗抗生素耐药性。试验注册荷兰试验注册 NL5054 当前研究期间生成和分析的数据集将在研究结果发表后,在研究结束后最多九个月内存放在存储库 DANS (EASY) 中。所涉及的数据集将被匿名化,并且可以在限制下访问。
更新日期:2021-09-21
down
wechat
bug