Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: A multicentre randomised controlled trial
by Mariana Bichuette Cartuliares, Flemming Schønning Rosenvinge, Christian Backer Mogensen, Thor Aage Skovsted, Steen Lomborg Andersen, Claus Østergaard, Andreas Kristian Pedersen, Helene Skjøt-arkil
Background
Rapid and accurate detection of pathogens is needed in community-acquired pneumonia (CAP) to enable appropriate antibiotics and to slow the development of antibiotic resistance. We aimed to compare the effect of point-of-care (POC) polymerase chain reaction (PCR) detection of respiratory pathogens added to standard care withstandard care only (SCO) on antibiotic prescriptions after acute hospital admission.
Methods and findings
We performed a superiority, parallel-group, open-label, multicentre, randomised controlled trial (RCT) in 3 Danish medical emergency departments (EDs) from March 2021 to February 2022. Adults acutely admitted with suspected CAP during the daytime on weekdays were included and randomly assigned (1:1) to POC-PCR (The Biofire FilmArray Pneumonia Panel plus added to standard care) or SCO (routine culture and, if requested by the attending physician, target-specific PCR) analysis of respiratory samples. We randomly assigned 294 patients with successfully collected samples (tracheal secretion 78.4% or expectorated sputum 21.6%) to POC-PCR (n = 148, 50.4%) or SCO (146, 49.6%). Patients and investigators owning the data were blinded to the allocation and test results. Outcome adjudicators and clinical staff at the ED were not blinded to allocation and test results but were together with the statistician, blinded to data management and analysis. Laboratory staff performing standard care analyses was blinded to allocation. The study coordinator was not blinded. Intention-to-treat and per protocol analysis were performed using logistic regression with Huber–White clustered standard errors for the prescription of antibiotic treatment. Loss to follow-up comprises 3 patients in the POC-PCR (2%) and none in the SCO group. Intention-to-treat analysis showed no difference in the primary outcome of prescriptions of noor narrow-spectrum antibiotics at 4 h after admission for the POC-PCR (n = 91, 62.8%) odds ratio (OR) 1.13; (95% confidence interval (CI) [0.96, 1.34] p = 0.134)andSCO (n = 87, 59.6%). Secondary outcomes showed that prescriptions were significantly more targeted at 4-h OR 5.68; (95% CI [2.49, 12.94] p p p = 0.006)and on day 5 inthe POC-PCR group OR 1.40; (95% CI [1.18, 1.66] p p = 0.475), readmission within 30 days OR 0.90; (95% CI [0.43, 1.86] p = 0.787), length of stay (LOS) IRR 0.82; (95% CI [0.63, 1.07] p = 0.164), 30 days mortality OR 1.24; (95% CI [0.32, 4.82] p = 0.749),andin-hospital mortality OR 0.98; (95% CI [0.19, 5.06] p = 0.986).
Conclusions
In a setting with an already restrictive use of antibiotics, adding POC-PCR to the diagnostic setup did not increase the number of patients treated with narrow-spectrum or without antibiotics. POC-PCR may result in a more targeted and adequate use of antibiotics. A significant study limitation was the concurrent Coronavirus Disease 2019 (COVID-19) pandemic resulting in an unusually low transmission of respiratory virus.
Trial registration
ClinicalTrials.gov (NCT04651712).
Our "Network":Project Gutenberg
https://gutenberg.classicistranieri.com
EncyclopaediaBritannica1911
https://encyclopaediabritannica.classicistranieri.com
Librivox Audiobooks
https://librivox.classicistranieri.com
Linux Distributions
https://old.classicistranieri.com
Magnatune (MP3 Music)
https://magnatune.classicistranieri.com
Static Wikipedia (June 2008)
https://wikipedia.classicistranieri.com
Static Wikipedia (March 2008)
https://wikipedia2007.classicistranieri.com/mar2008/
Static Wikipedia (2007)
https://wikipedia2007.classicistranieri.com
Static Wikipedia (2006)
https://wikipedia2006.classicistranieri.com
Liber Liber
https://liberliber.classicistranieri.com
ZIM Files for Kiwix
https://zim.classicistranieri.com
Other Websites:
Bach - Goldberg Variations
https://www.goldbergvariations.org
Lazarillo de Tormes
https://www.lazarillodetormes.org
Madame Bovary
https://www.madamebovary.org
Il FuMattiaPascal
https://www.mattiapascal.it
The Voice in the Desert
https://www.thevoiceinthedesert.org
Confessione d'un amorefascista
https://www.amorefascista.it
Malinverno
https://www.malinverno.org
Debito formativo
https://www.debitoformativo.it
Adina Spire
https://www.adinaspire.com