C 反应蛋白即时检测对初级保健中疑似呼吸道感染的儿童和成人抗生素处方的影响：一项法国患者水平随机对照优效性试验。

Impact of C-reactive protein point-of-care testing on antibiotic prescriptions for children and adults with suspected respiratory tract infections in primary care: a French patient-level randomized controlled superiority trial.

机构信息

Clinical Research Centre, Centre Hospitalier Intercommunal (CHI) Creteil, Creteil, France; Institut Mondor de Recherche Biomédicale-Groupement de Recherche Clinique GEMINI (IMRB-GRC GEMINI), University of Paris Est, Creteil, France; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France; Association Française de Pédiatrie Ambulatoire, Villeneuve Les Avignons, France.

出版信息

Clin Microbiol Infect. 2024 Dec;30(12):1553-1558. doi: 10.1016/j.cmi.2024.07.014. Epub 2024 Jul 26.

DOI:10.1016/j.cmi.2024.07.014

PMID:39067513

Abstract

OBJECTIVES

The value of C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescriptions in adults has previously been emphasized. The aim of this study was to assess the impact of CRP POCT on antibiotic prescriptions by general practitioners (GPs) for suspected lower respiratory tract infections in children ≥3 years old and in adults.

METHODS

This was an open-label randomized trial (NCT03540706) conducted in 26 GPs in France between October 2019 and March 2023. Of the 404 participating patients, 207 (51.2%) were randomized to the CRP POCT group and 197 (48.8%) to the control group (i.e. no CRP POCT). During consultations, GPs measured CRP levels in patients randomized to the CRP POCT group. The primary endpoint was the proportion of patients in each group who were prescribed antibiotics by their GP during the consultation. Z-tests were used for comparisons.

RESULTS

The overall proportion of patients treated with antibiotics was similar in the CRP POCT (n = 89/207, 43% CI: 36.2, 50.0) and in the control group (n = 94/197, 47.7% CI: 40.6, 54.9), difference: -4.7 CI: -14.4, 5.0; p 0.3. Overall, 75% of the GPs followed CRP-based antibiotic prescription recommendations in the CRP POCT group.

DISCUSSION

CRP POCT did not reduce antibiotic prescriptions in this trial.

摘要

目的

先前强调了 C 反应蛋白即时检测（CRP POCT）在指导成人抗生素处方方面的价值。本研究旨在评估 CRP POCT 对疑似下呼吸道感染的≥3 岁儿童和成人的全科医生（GP）抗生素处方的影响。

方法

这是一项在法国 26 名 GP 中进行的开放标签随机试验（NCT03540706），时间为 2019 年 10 月至 2023 年 3 月。在 404 名参与患者中，207 名（51.2%）被随机分配到 CRP POCT 组，197 名（48.8%）分到对照组（即无 CRP POCT）。在就诊期间，GP 为 CRP POCT 组的患者测量 CRP 水平。主要终点是每组中由 GP 在就诊期间开具抗生素的患者比例。使用 Z 检验进行比较。

结果

CRP POCT 组（n=89/207，43% CI：36.2，50.0）和对照组（n=94/197，47.7% CI：40.6，54.9）接受抗生素治疗的患者比例总体相似，差异为-4.7 CI：-14.4，5.0；p=0.3。总体而言，在 CRP POCT 组中，75%的 GP 遵循基于 CRP 的抗生素处方建议。