CRP POCT implementation in nursing homes may help combat antibiotic resistance: BMJ Study
Netherlands: A recent study showed C reactive protein point-of-care testing (CRP POCT) to safely reduce antibiotic prescribing for suspected lower respiratory tract infections in nursing home residents. The findings, published in the BMJ, suggest that the implementation of CRP POCT in nursing homes may reduce antibiotic use in this setting and help combat antibiotic resistance.
Inappropriate antibiotic use is an important driving force for the increasing worldwide prevalence of antimicrobial resistance as a public health threat. Owing to the high infection burden, frailty, and higher risk of serious clinical outcomes, antibiotic prescription rates are relatively high in the nursing home setting in this population.
CRP POCT for suspected lower respiratory tract infections might contribute to prompt and appropriate decisions of whether or not to prescribe antibiotics or to suggest additional investigations.
Tjarda M Boere, VU University Medical Center, Amsterdam, Netherlands, and colleagues aimed to evaluate whether CRP POCT safely reduces antibiotic prescribing for lower respiratory tract infections in nursing home residents.
For this purpose, the researchers designed a pragmatic, cluster randomized controlled trial in a setting of the UPCARE study including 11 nursing home organizations in the Netherlands. 84 physicians from 11 nursing home organizations included 241 participants with suspected lower respiratory tract infections from September 2018 to the end of March 2020.
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.
The primary outcome measure was antibiotic prescribing at the initial consultation.
Antibiotics were prescribed at initial consultation for 84 (53.5%) patients in the intervention group and 65 (82.3%) in the control group.
Key findings include:
- Patients in the intervention group had 4.93 higher odds 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.
"Our findings showed that C reactive protein point-of-care testing was found to safely reduce antibiotic prescribing for suspected lower respiratory tract infections in nursing home residents compared with usual care (between-group difference at initial consultation 28.8%)," wrote the authors.
Reference:
The study titled, "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," is published in The BMJ.
DOI: https://www.bmj.com/content/374/bmj.n2198
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