小柯机器人

荷兰阿姆斯特丹VU大学医学中心Laura W van Buul团队研究了护理点C反应蛋白检测对疗养院居民下呼吸道感染抗生素处方的影响。相关论文于2021年9月21日发表在《英国医学杂志》上。

为了评估C反应蛋白护理点检测（CRP POCT）是否能安全减少疗养院居民下呼吸道感染的抗生素处方，研究组在荷兰的11家疗养院机构进行了一项实用的、分组随机对照试验。2018年9月至2020年3月底，11家养老院机构的84名医生接诊了241名疑似下呼吸道感染患者。

分配给干预组的疗养院为患者提供CRP POCT。对照组为患者提供常规护理，无CRP POCT。主要疗效指标为初次会诊时的抗生素处方。次要结局指标为三周时的完全恢复、一周和三周时随访期间抗生素管理的变化和额外诊断、入院和任何时间点（首次会诊、一周或三周）的全因死亡率。

干预组84例（53.5%）患者和对照组65例（82.3%）患者在初次会诊时使用抗生素。与对照组相比，干预组患者在初次会诊时未使用抗生素的几率高出4.93，与治疗医生和基线特征无关。从最初咨询到随访的任何时间点，组间抗生素处方差异为23.6%。关于次要结局，干预组和对照组患者在三周时完全恢复率分别为86.4%和90.8%，差异为4.4%；全因死亡率分别为3.5%和1.3%，差异为2.2%；住院率分别为7.2%与6.5%，差异为0.7%，这三项次要结局均无显著差异。

结果表明，CRP POCT对疑似下呼吸道感染患者的治疗安全地减少了疗养院居民的抗生素处方。在疗养院实施CRP-POCT可能有助于减少该环境下的抗生素使用，并有助于对抗抗生素耐药性。

附：英文原文

Title: 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

Author: Tjarda M Boere, Laura W van Buul, Rogier M Hopstaken, Maurits W van Tulder, Jos W M R Twisk, Theo J M Verheij, Cees M P M Hertogh

Issue&Volume: 2021/09/21

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.

DOI: 10.1136/bmj.n2198

Source: https://www.bmj.com/content/374/bmj.n2198

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