Improved diagnostics for pneumonia in nursing homes

Using Point-of-care C-reactive protein to guide Antibiotic prescribing for Respiratory tract infections in Elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial

Tjarda Boere, Laura van Buul, T. Verheij, Cees Hertogh

De abstractcommissie heeft op verzoek van de congrescommissie 6 abstracts geselecteerd die tijdens het Verenso najaarscongres 'Oud en benauwd' op 29 november 2018 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.

Introduction

Antibiotics are over-prescribed for lower respiratory tract infection (LRTI) in nursing homes (NH) due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side-effects and drug interactions, and on societal level, given the potential development of antibiotic resistance. The diagnosis of LRTI is challenging in NHs, because of limited availability and applicability of diagnostic tools, and because NH residents often lack typical symptoms. In addition, cognitive disabilities can impede communication of experienced complaints. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce unnecessary antibiotic use for LRTI in NHs.

Methods

Study design

A cluster Randomized Controlled Trial (cRCT) will be conducted in twelve NHs in the Netherlands between September 2018 and March 2020. NHs in the control group will provide usual care, and NHs in the intervention group will provide usual care including CRP POCT for NH residents with (suspected) LRTI.

Study population

NH residents with a new diagnosis ‘suspected LRTI’ can participate in the cRCT. Patients are excluded if they receive palliative or terminal care, if they do not wish to be treated with antibiotics, if they have a different type of infection or if they are already taking antibiotics.

Main outcomes

1. Antibiotic prescribing for suspected LRTI at index consultation (yes/no)
2. Associations between CRP POCT values and:
    a) signs and symptoms in NH patients with suspected LRTI
    b) antibiotic treatment (yes/no)
3. Cost-effectiveness and cost-benefit of the use of CRP POCT

Results/conclusions

Expected in 2020.