Point-of-care-test op CRP leidt tot minder antibioticavoorschriften

Objective

To evaluate whether C reactive protein point-of-care testing (CRP POCT) safely reduces antibiotic prescribing for lower respiratory tract infections (LRTI) in nursing home residents.

Design

Pragmatic, cluster randomised controlled trial.

Method

We included 241 participants with suspected LRTI, from 11 nursing home organisations in the Netherlands (September 2018 - March 2020). Nursing homes allocated to the intervention group had access to CRP POCT; control group nursing homes provided usual care without CRP POCT. The primary outcome measure was antibiotic prescribing at initial consultation. Secondary outcome measures were full recovery, changes in antibiotic management, additional diagnostics, hospital admission and all-cause mortality during follow-up (3 weeks).

Results

Antibiotics were prescribed at initial consultation for 84 (53.5%) intervention group and 65 (82.3%) control group patients. 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. The between group difference in antibiotic prescribing at any point from initial consultation to follow-up was 23.6%. Differences in secondary outcomes (all non-significant) between the intervention and control groups were 4.4% in full recovery rates (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%).

Conclusion

CRP POCT for suspected LRTI 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.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.