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Impact of low-dose chest computed tomography and multiplex PCR on antibiotic usage for community-acquired pneumonia:
L Zhang1, R M Aleva2, H S M Ammerlaan3
1Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands.
Objectives:
We investigated if low-dose chest computed tomography (CT) or multiplex point-of-care PCR (PoC-PCR) for respiratory pathogens can safely reduce broad-spectrum antibiotic use in patients with moderate-to-severe community-acquired pneumonia (CAP).
Methods:
Multicentre prospective controlled before-after study with cluster randomization. Randomization was stratified by implementation feasibility. Five teaching, one nonteaching, and one university hospital in the Netherlands. Adults with initial diagnosis of CAP requiring admission to nonintensive care unit ward. Low-dose CT or PoC-PCR implemented in routine care with antibiotic treatment recommendations compared with standard care. Superiority of days on therapy with broad-spectrum antibiotics and noninferiority of all-cause 90-day mortality based on intention-to-treat.
Results:
The study was started in December 2017 and terminated prematurely in March 2020 because of substantial changes in routine diagnostic practice for CAP during the COVID-19 pandemic. After the baseline period (2245 patients), 561 patients were included in the low-dose CT group (two hospitals), 910 in the PoC-PCR group (two hospitals), and 2084 in standard care (three hospitals). All included patients were analysed. CT was performed in 40% of patients in the low-dose CT group, and PCR testing was done in 67% in the PoC-PCR group. Compared with standard care, the adjusted relative risk on days on therapy broad-spectrum antibiotics was 1.12 (95% CI 0.90-1.38) for low-dose CT and 0.89 (95% CI 0.75-1.04) for PoC-PCR. Noninferiority was demonstrated for PoC-PCR but not for low-dose CT.
Conclusions:
In patients with moderate-to-severe CAP, it is unlikely that low-dose chest CT impacts broad-spectrum antibiotic treatment, whereas a relevant effect could not be demonstrated nor excluded for PoC-PCR. Trial registration at clinicaltrials.gov (NCT03360851).
Insights
Low-dose chest CT did not significantly reduce broad-spectrum antibiotic use in community-acquired pneumonia (CAP) patients. Multiplex Point-of-Care PCR (PoC-PCR) showed potential but requires further investigation for antibiotic treatment impact.
Area of Science:
- Infectious Diseases
- Radiology
- Medical Diagnostics
Background:
- Community-acquired pneumonia (CAP) management often involves broad-spectrum antibiotics.
- Optimizing diagnostic strategies is crucial to reduce antibiotic overuse and resistance.
- Novel diagnostic tools like low-dose CT and PoC-PCR are being explored for CAP.
Purpose of the Study:
- To evaluate if low-dose chest computed tomography (CT) or multiplex Point-of-Care PCR (PoC-PCR) can reduce broad-spectrum antibiotic use in moderate-severe CAP.
- To assess the impact of these diagnostic methods on antibiotic treatment duration and patient mortality.
Main Methods:
- A multicentre prospective controlled before-after study with cluster randomisation was conducted in the Netherlands.
- Adult CAP patients received either low-dose CT, PoC-PCR, or standard care, with antibiotic treatment recommendations provided.
- The study compared days on broad-spectrum antibiotic therapy (DOT) and 90-day all-cause mortality.
Main Results:
- Low-dose CT did not demonstrate non-inferiority in reducing DOT for broad-spectrum antibiotics compared to standard care.
- PoC-PCR showed non-inferiority for DOT, with an adjusted relative risk of 0.89 (95% CI 0.75 to 1.04).
- The study was prematurely terminated due to COVID-19 pandemic-related changes in diagnostic practices.
Conclusions:
- Low-dose chest CT is unlikely to significantly impact broad-spectrum antibiotic treatment in moderate-severe CAP.
- A relevant effect of PoC-PCR on antibiotic treatment could not be definitively demonstrated or excluded.
- Further research is needed to clarify the role of PoC-PCR in optimizing antibiotic use for CAP.
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