CRP point of care testing in respiratory tract infections resulted in major reduction of antibiotic prescribing in nursing homes

The first results of the UPCARE study (Using Point-of-care C-reactive protein to Guide Antibiotic Prescribing for Respiratory Tract Infections in Elderly Nursing Home Residents) are now published.

The UPCARE study was conducted in the Netherlands and investigated whether the use of CRP point of care (POC) testing in nursing homes reduces unnecessary antibiotic prescribing for lower respiratory tract infections compared to nursing homes without access to CRP POC testing. The study also paid attention to the cost-effectiveness and implementation procedure of CRP POC testing in nursing homes, but those results will be published later.

The CRP measurements were performed using QuikRead go CRP. In nursing homes, antibiotic use is relatively high because of the frailty of residents and the high risk for serious outcomes of infections. In addition, diagnostic resources are usually limited making differentiation of self-limiting and serious infections difficult. This diagnostic uncertainty easily drives for antibiotic overprescribing in cases when antibiotics are not necessary.

CRP POC testing in nursing homes resulted in a 29 % reduction of antibiotic prescribing at the initial consultation compared to usual care. In addition to that the reduction of antibiotic use was substantial, it was an important finding that the full recovery stayed high, and hospitalizations or mortality did not increase. Also, patients in the CRP POC group had fever changes in antibiotic treatment such as cessations, switch to another antibiotic, or prolongation compared to the control group.

These results suggest that CRP POC testing aids in fighting against antimicrobial resistance by reducing unnecessary antibiotic use in nursing homes.

Read the original article: https://doi.org/10.1136/bmj.n2...