现在的位置: 首页时讯速递, 进展交流>正文
[BMJ发表论文]:PCT与肺部超声确定下呼吸道感染患者的抗生素使用
2021年10月28日 时讯速递, 进展交流 暂无评论

Research

Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: pragmatic cluster randomised trial

Loïc Lhopitallier, Andreas Kronenberg, Jean-Yves Meuwly, et al

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2132 (Published 21 September 2021)Cite this as: BMJ 2021;374:n2132

Abstract

Objective To assess whether point-of care procalcitonin and lung ultrasonography can safely reduce unnecessary antibiotic treatment in patients with lower respiratory tract infections in primary care.

Design Three group, pragmatic cluster randomised controlled trial from September 2018 to March 2020.

Setting 60 Swiss general practices.

Participants One general practitioner per practice was included. General practitioners screen all patients with acute cough; patients with clinical pneumonia were included.

Interventions Randomisation in a 1:1:1 of general practitioners to either antibiotics guided by sequential procalcitonin and lung ultrasonography point-of-care tests (UltraPro; n=152), procalcitonin guided antibiotics (n=195), or usual care (n=122).

Main outcomes Primary outcome was proportion of patients in each group prescribed an antibiotic by day 28. Secondary outcomes included duration of restricted activities due to lower respiratory tract infection within 14 days.

Results 60 general practitioners included 469 patients (median age 53 years (interquartile range 38-66); 278 (59%) were female). Probability of antibiotic prescription at day 28 was lower in the procalcitonin group than in the usual care group (0.40 v 0.70, cluster corrected difference −0.26 (95% confidence interval −0.41 to −0.10)). No significant difference was seen between UltraPro and procalcitonin groups (0.41 v 0.40, −0.03 (−0.17 to 0.12)). The median number of days with restricted activities by day 14 was 4 days in the procalcitonin group and 3 days in the usual care group (difference 1 day (95% confidence interval −0.23 to 2.32); hazard ratio 0.75 (95% confidence interval 0.58 to 0.97)), which did not prove non-inferiority.

Conclusions Compared with usual care, point-of-care procalcitonin led to a 26% absolute reduction in the probability of 28 day antibiotic prescription without affecting patients’ safety. Point-of-care lung ultrasonography did not further reduce antibiotic prescription, although a potential added value cannot be excluded, owing to the wide confidence intervals.

Trial registration ClinicalTrials.gov NCT03191071.

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博