Schuijt Tim J, Boss David S, Musson Ruben E A, Demir Ayse Y
Laboratory for Clinical Chemistry and Haematology, Meander Medical Center, Amersfoort, The Netherlands.
SALTRO, Diagnostic Center for Primary Care, Utrecht, The Netherlands.
Fam Pract. 2018 Mar 27;35(2):179-185. doi: 10.1093/fampra/cmx081.
Bacterial resistance to antibiotics represents a serious global challenge that is associated with high morbidity and mortality. One of the most important causes of this threat is antibiotic overuse. The Dutch College of General Practitioners (DCGP) recommends the use of point-of-care (POC) testing for C-reactive protein (CRP) in two guidelines ('Acute Cough' and 'Diverticulitis') to achieve a more sensible prescription pattern of antibiotics.
To evaluate the use of POC-CRP testing in light of the DCGP guidelines and the effect of CRP measurements on antibiotic prescription policy in primary care.
In a prospective observational study, which included 1756 patients, general practitioners (GPs) were asked to complete a questionnaire after every POC-CRP testing, stating the indication for performing the test, the CRP result and their decision whether or not to prescribe antibiotics. Indications were verified against the DCGP guidelines and categorized. Antibiotic prescription was evaluated in relation to CRP concentrations.
Indications to perform POC-CRP test and the prescription pattern of antibiotics based on CRP value varied considerably between GPs. Differences in antibiotic prescription rate were most obvious in patients who presented with CRP values between 20 and 100 mg/l, and could in part be explained by the indication for performing POC-CRP test and patient age. Most GPs followed the DCGP guidelines and used low CRP values to underpin their decision to refrain from antibiotic prescription. Peer-based reflection on differences in POC-CRP usage and antibiotic prescription rate amongst GPs may further nourish a more critical approach to prescription of antibiotics.
细菌对抗生素的耐药性是一项严峻的全球挑战，与高发病率和死亡率相关。这种威胁的最重要原因之一是抗生素的过度使用。荷兰全科医生学院（DCGP）在两项指南（“急性咳嗽”和“憩室炎”）中建议使用即时检验（POC）检测C反应蛋白（CRP），以实现更合理的抗生素处方模式。
根据DCGP指南评估POC-CRP检测的使用情况以及CRP测量对初级保健中抗生素处方政策的影响。
在一项纳入1756名患者的前瞻性观察研究中，要求全科医生（GPs）在每次POC-CRP检测后填写一份问卷，说明进行检测的指征、CRP结果以及他们是否开抗生素的决定。根据DCGP指南对指征进行核实并分类。根据CRP浓度评估抗生素处方情况。
不同全科医生进行POC-CRP检测的指征以及基于CRP值的抗生素处方模式差异很大。在CRP值为20至100mg/l的患者中，抗生素处方率的差异最为明显，部分原因可以通过进行POC-CRP检测的指征和患者年龄来解释。大多数全科医生遵循DCGP指南，并使用低CRP值作为他们不使用抗生素处方的依据。基于同行的对全科医生之间POC-CRP使用和抗生素处方率差异的反思可能会进一步促进对抗生素处方采取更严格的方法。
