Point-of-care multiplex molecular diagnosis coupled with procalcitonin-guided algorithm for antibiotic stewardship in lower respiratory tract infection: a randomized controlled trial
Abstract
OBJECTIVE
We aimed to show that coupling molecular syndromic respiratory panel (RP) testing with procalcitonin (PCT) measurement in the emergency department improves antibiotic (ATB) stewardship in lower respiratory tract infection (LRTI).
METHODS
Open label, prospective, randomized interventional trial, conducted from 2019 to 2022 in an adult emergency department. Patients with a suspicion of LRTI were randomized into an intervention arm (PCT measurement and point of care BIOFIRE® RP2.1 plus testing, accompanied by a recommended ATB algorithm) or a standard of care (SOC) arm (PCT allowed as current practice). The primary endpoint was the duration of antibiotic exposure.
RESULTS
451 patients were randomized, median age 65 years (Q1-Q3: 49 - 77), hospitalization rate was 59.9% (270/451), median length of stay 5 days (Q1-Q3: 3 - 12), and 28-day mortality rate 5.3% (23/451). The median duration of ATB exposure was 6 days (Q1-Q3: 0 - 9) and 5 days (Q1-Q3: 0 - 9) in the SOC and interventional arm respectively (p=0.71). ATB was started in 29.6 % (67/226) and 33.8% (76/225) respectively (p=0.54). The BIOFIRE® RP2.1 plus identified at least one viral species in 112/225 patients (49.8%) of intervention arm. 212/226 (93.8%) SOC patients had PCT measurement. The adherence rate to algorithm in the intervention arm was 93.3 % (210/225).
CONCLUSION
Displaying PCT and real-time RP results to emergency physicians failed to significantly reduce ATB exposure in LRTI suspicions. However, the…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 451 participants or records.
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