1. In this superiority, parallel-group, open-label, multicentre, randomised controlled trial (RCT), point-of-care (POC) polymerase chain reaction (PCR) testing resulted in earlier use of targeted and adequate antibiotics, but did not result in less antibiotic use compared to the standard of care only (SCO).

Evidence Rating Level: 1 (Excellent)

With increasing rates of antimicrobial resistance worldwide, the topic of antibiotic stewardship is one of importance and developing efficient and effective ways to avoid antibiotic misuse and excessive use is pertinent. Community-acquired pneumonia (CAP) is a relatively common patient presentation which can have serious consequences if left untreated. Point-of-care (POC) polymerase chain reaction (PCR) testing presents a potential medium by which healthcare providers can more efficiently discontinue broad spectrum empiric antibiotics when not necessary and reduce the length of hospitalization. This method of testing has yet to be studied in the emergency department (ED) setting, which is exactly what the current study sought to do. The multicentre randomized study was conducted in three Danish hospitals and adults whose emergency physicians suspected CAP were invited to participate. Patients with suspected pneumonia (n = 291; median age 73, 51% male) were randomized 1:1 to either the POC-PCR group, or the standard care only (SCO) group. Those in the experimental group received results of POC-PCR from a sputum sample within 4 hours. POC-PCR was not found to be superior to SCO regarding prescriptions of ‘no or narrow-spectrum antibiotics’ within 4 hours of admission, and more patients in the SCO group were being treated with no or narrow spectrum treatments at the 5-day mark, which is likely due to the resulting of cultures. However, targeted and adequate antibiotics were used significantly more often in the POC-PCR group earlier on (both at 4 hours and 48 hours; p < .05), indicating that this method of testing can allow providers to make rapid, targeted decisions around antibiotic prescribing. There were no differences in mortality, admissions to ICU, or 30-day readmission between the groups. Length of stay was nonsignificant but was decreased for the POC-PCR group (4.3 vs 3.6 days, p = .164). The results of this study contradict some of the more promising findings of POC-PCR but should be replicated in environments where there is more resistance. There is also promise in the fact that targeted antibiotics were more efficiently selected when using POC-PCR in early stages of treatment.

Click to read the study in PLOS ONE

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