Objectives & Background The World Health Organisation has identified antimicrobial resistance as “an increasingly serious threat to global public health that requires action across all government sectors and society”, and state that “health workers should only prescribe antibiotics when they are truly needed”.
The Emergency Department (ED) at Bradford Royal Infirmary is a busy urban ED, with significant numbers of patients attending with lower respiratory tract infections, particularly in the winter months. NICE CG191 (Pneumonia in Adults, December 2014) recommends the use of point of care (POC) CRP testing to guide antibiotic therapy in primary care. This study aims to evaluate the impact of POC CRP testing in ED patients with low risk Community Acquired Pneumonia (CAP).
Methods A before and after study was performed. We included adults (aged 16 years and above) presenting to the ED with suspected Lower Respiratory Tract Infection (LRTI) AND CURB-65 score 0–1. During the pre-intervention phase (November 2015–January 2016) patients were managed using the pre-existing ED CAP guideline. During the intervention phase (February–March 2016) patients meeting the inclusion criteria underwent POC CRP testing, and the results of this were used to guide antibiotic prescribing. Retrospective analysis of the ED documentation and hospital results systems was performed to determine antibiotic prescribing rates, return to the ED within 30 days, and subsequent new radiographic pneumonia within 30 days of ED presentation.
Results 143 patients were included (50 pre-intervention, 93 post-intervention). Baseline characteristics were similar in both study periods. Antibiotic prescribing rates were significantly lower in the POC CRP group (20% versus 70%, p<0.0001 Fisher's exact test). There was no significant difference in the proportion of patients returning to the ED within 30 days requiring further treatment for LRTI (2.2% POC CRP group versus 6% pre-intervention, p=0.34). No patients in either group developed new radiological pneumonia within 30 days of ED presentation.
Conclusion The introduction of POC CRP testing in ED patients with suspected CAP led to a significant reduction in antibiotic prescribing rates. This is consistent with evidence from primary care and NICE guidance, and we advocate the wider use of POC CRP testing in this group of patients in the ED.
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