Impact of C-reactive protein point-of-care testing on antibiotic prescriptions for children and adults with suspected respiratory tract infections in primary care: a French patient-level randomized controlled superiority trial

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2024-07-26 DOI:10.1016/j.cmi.2024.07.014

Camille Jung , Corinne Levy , Stéphane Béchet , Philippe Aegerter , Robert Cohen , Robert Touitou

{"title":"Impact of C-reactive protein point-of-care testing on antibiotic prescriptions for children and adults with suspected respiratory tract infections in primary care: a French patient-level randomized controlled superiority trial","authors":"Camille Jung , Corinne Levy , Stéphane Béchet , Philippe Aegerter , Robert Cohen , Robert Touitou","doi":"10.1016/j.cmi.2024.07.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>The value of C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescriptions in adults has previously been emphasized. The aim of this study was to assess the impact of CRP POCT on antibiotic prescriptions by general practitioners (GPs) for suspected lower respiratory tract infections in children ≥3 years old and in adults.</div></div><div><h3>Methods</h3><div>This was an open-label randomized trial (NCT03540706) conducted in 26 GPs in France between October 2019 and March 2023. Of the 404 participating patients, 207 (51.2%) were randomized to the CRP POCT group and 197 (48.8%) to the control group (i.e. no CRP POCT). During consultations, GPs measured CRP levels in patients randomized to the CRP POCT group. The primary endpoint was the proportion of patients in each group who were prescribed antibiotics by their GP during the consultation. Z-tests were used for comparisons.</div></div><div><h3>Results</h3><div>The overall proportion of patients treated with antibiotics was similar in the CRP POCT (<em>n</em> = 89/207, 43% CI: 36.2, 50.0) and in the control group (<em>n</em> = 94/197, 47.7% CI: 40.6, 54.9), difference: −4.7 CI: −14.4, 5.0; p 0.3. Overall, 75% of the GPs followed CRP-based antibiotic prescription recommendations in the CRP POCT group.</div></div><div><h3>Discussion</h3><div>CRP POCT did not reduce antibiotic prescriptions in this trial.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"30 12","pages":"Pages 1553-1558"},"PeriodicalIF":10.9000,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1198743X24003434","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

The value of C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescriptions in adults has previously been emphasized. The aim of this study was to assess the impact of CRP POCT on antibiotic prescriptions by general practitioners (GPs) for suspected lower respiratory tract infections in children ≥3 years old and in adults.

Methods

This was an open-label randomized trial (NCT03540706) conducted in 26 GPs in France between October 2019 and March 2023. Of the 404 participating patients, 207 (51.2%) were randomized to the CRP POCT group and 197 (48.8%) to the control group (i.e. no CRP POCT). During consultations, GPs measured CRP levels in patients randomized to the CRP POCT group. The primary endpoint was the proportion of patients in each group who were prescribed antibiotics by their GP during the consultation. Z-tests were used for comparisons.

Results

The overall proportion of patients treated with antibiotics was similar in the CRP POCT (n = 89/207, 43% CI: 36.2, 50.0) and in the control group (n = 94/197, 47.7% CI: 40.6, 54.9), difference: −4.7 CI: −14.4, 5.0; p 0.3. Overall, 75% of the GPs followed CRP-based antibiotic prescription recommendations in the CRP POCT group.

Discussion

CRP POCT did not reduce antibiotic prescriptions in this trial.

查看原文本刊更多论文

C 反应蛋白床旁检测对基层医疗机构为疑似呼吸道感染的儿童和成人开具抗生素处方的影响：法国患者水平随机对照优效试验。

目的：C 反应蛋白床旁检测（CRP POCT）在指导成人抗生素处方方面的价值先前已得到强调。本研究旨在评估CRP POCT对全科医生（GP）开具疑似下呼吸道感染处方的影响：这是一项开放标签随机试验（NCT03540706），于2019年10月至2023年3月期间在法国的26家全科医生中进行。在404名参与试验的患者中，207人（51.2%）被随机分配到CRP POCT组，197人（48.8%）被分配到对照组（即无CRP POCT）。在咨询过程中，全科医生会测量随机分配到 CRP POCT 组的患者的 CRP 水平。主要终点是各组患者在会诊期间由全科医生开具抗生素处方的比例。比较采用Z检验：结果：CRP POCT 组（n=89/207，43% CI[36.2;50.0]）和对照组（n=94/197，47.7% CI[40.6;54.9]）接受抗生素治疗的患者总比例相似，差异为-4.7CI[-15.0]：-4.7CI[-14.4;5.0]；P = 0.3。总体而言，在 CRP POCT 组中，75% 的全科医生遵循了基于 CRP 的抗生素处方建议：结论：在这项试验中，CRP POCT并未减少抗生素处方。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.