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Point-of-care testing reduces antibiotic prescribing in acute exacerbations of chronic obstructive pulmonary disease:
Xiying Li1, Shengyue Qiu1, Chaojie Liu2
1School of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, China.
Background:
Challenges in identifying the causes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to overuse of antibiotics. The advantages of point-of-care testing (POCT) may help to identify pathogens and use antibiotics more appropriately.
Methods:
We conducted a systematic review to evaluate the effect of POCT to guide antibiotic prescriptions for AECOPD. Adhering to a protocol (CRD42024555847), we searched eligible studies. The outcomes included antibiotic-related and clinical outcomes. We evaluated the risk of bias and performed meta-analyses with subgroup based on the type and testing timing of POCT.
Results:
A total of 18 studies evaluating 4346 AECOPD patients were included. Overall, POCT significantly reduced the number of AECOPD patients given antibiotic prescriptions by 16% (P < 0.001). Additionally, antibiotic treatment was reduced by 1.19 days (P = 0.04). There was no detrimental impact on clinical outcomes, such as the length of hospital stay (P = 0.19). Our results proved robust to sensitivity analyses.
Conclusion:
We offered reasonable evidence for using POCT to reduce antibiotic exposure for AECOPD without adversely affecting clinical outcomes. As diagnostic techniques become increasingly important in combating antimicrobial resistance, the use of POCT should be encouraged.
Insights
Point-of-care testing (POCT) significantly reduces antibiotic prescriptions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This approach lowers antibiotic use without negatively impacting patient clinical outcomes, aiding antimicrobial resistance efforts.
Area of Science:
- Pulmonary Medicine
- Infectious Disease
- Diagnostic Technologies
Background:
- Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) present diagnostic challenges, leading to widespread antibiotic overuse.
- Point-of-care testing (POCT) offers a potential solution for pathogen identification and optimizing antibiotic prescribing.
Purpose of the Study:
- To systematically review the impact of POCT on antibiotic prescriptions for AECOPD.
- To evaluate the effects of POCT on both antibiotic-related and clinical outcomes in AECOPD patients.
Main Methods:
- A systematic review was conducted following a registered protocol (CRD42024555847).
- Searched for eligible studies evaluating POCT for AECOPD antibiotic guidance.
- Performed meta-analyses, including subgroup analyses by POCT type and timing, and assessed risk of bias.
Main Results:
- Included 18 studies with 4346 AECOPD patients.
- POCT reduced antibiotic prescriptions by 16% (P < 0.001) and duration by 1.19 days (P = 0.04).
- No adverse effects on clinical outcomes like hospital stay (P = 0.19) were observed; results were robust.
Conclusions:
- POCT provides evidence for reducing antibiotic exposure in AECOPD without compromising clinical outcomes.
- Encouraging POCT use is vital for combating antimicrobial resistance through improved diagnostics.
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