Gonzales Ralph, Aagaard Eva M, Camargo Carlos A, Ma O John, Plautz Mark, Maselli Judith H, McCulloch Charles E, Levin Sara K, Metlay Joshua P
Department of Medicine, University of California, San Francisco, San Francisco, California 94118, USA.
J Emerg Med. 2011 Jul;41(1):1-7. doi: 10.1016/j.jemermed.2008.06.021. Epub 2008 Dec 17.
Antibiotics are commonly overused in adults seeking emergency department (ED) care for acute cough illness.
To evaluate the effect of a point-of-care C-reactive protein (CRP) blood test on antibiotic treatment of acute cough illness in adults.
A randomized controlled trial was conducted in a single urban ED in the United States. The participants were adults (age ≥ 18 years) seeking care for acute cough illness (≤ 21 days duration); 139 participants were enrolled, and 131 completed the ED visit. Between November 2005 and March 2006, study participants had attached to their medical charts a clinical algorithm with recommendations for chest X-ray study or antibiotic treatment. For CRP-tested patients, recommendations were based on the same algorithm plus the CRP level.
There was no difference in antibiotic use between CRP-tested and control participants (37% [95% confidence interval (CI) 29-45%] vs. 31% [95% CI 23-39%], respectively; p = 0.46) or chest X-ray use (52% [95% CI 43-61%] vs. 48% [95% CI 39-57%], respectively; p = 0.67). Among CRP-tested participants, those with normal CRP levels received antibiotics much less frequently than those with indeterminate CRP levels (20% [95% CI 7-33%] vs. 50% [95% CI 32-68%], respectively; p = 0.01).
Point-of-care CRP testing does not seem to provide any additional value beyond a point-of-care clinical decision support for reducing antibiotic use in adults with acute cough illness.
在因急性咳嗽疾病前往急诊科就诊的成年人中，抗生素普遍存在过度使用的情况。
评估即时检测C反应蛋白（CRP）血液检测对成人急性咳嗽疾病抗生素治疗的影响。
在美国一家城市急诊科进行了一项随机对照试验。参与者为因急性咳嗽疾病（病程≤21天）前来就诊的成年人（年龄≥18岁）；共招募了139名参与者，131人完成了急诊就诊。在2005年11月至2006年3月期间，研究参与者在其病历上附上了一份临床算法，其中包含胸部X线检查或抗生素治疗的建议。对于接受CRP检测的患者，建议基于相同的算法加上CRP水平。
接受CRP检测的参与者与对照组参与者在抗生素使用方面无差异（分别为37%[95%置信区间（CI）29 - 45%]和31%[95%CI 23 - 39%]；p = 0.46），在胸部X线使用方面也无差异（分别为52%[95%CI 43 - 61%]和48%[95%CI 39 - 57%]；p = 0.67）。在接受CRP检测的参与者中，CRP水平正常者使用抗生素的频率远低于CRP水平不确定者（分别为20%[95%CI 7 - 33%]和50%[95%CI 32 - 68%]；p = 0.01）。
对于减少急性咳嗽疾病成人患者的抗生素使用，即时检测CRP似乎并未提供超出即时临床决策支持的额外价值。
