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Randomized Controlled Trial
. 2021 Sep 21:374:n2198.
doi: 10.1136/bmj.n2198.

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

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
Affiliations
Randomized Controlled Trial

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

Tjarda M Boere et al. BMJ. .

Erratum in

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.

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Conflict of interest statement

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.

Figures

Fig 1
Fig 1
Antibiotic prescribing at initial consultation across categories of C reactive protein values (intervention group)
Fig 2
Fig 2
Average number of antibiotic prescriptions (all indications, ATC code J01) per 1000 resident days per month in the intervention group and control group
See this image and copyright information in PMC

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