Overruling of Procalcitonin-Guided Antibiotics for Lower Respiratory Tract Infections in Primary Care : Ancillary Study of a Randomized Controlled Trial
BACKGROUND: Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients with low procalcitonin at baseline received antibiotics by day 28.
AIM: To explore the factors associated with the overruling of initial procalcitonin guidance.
DESIGN AND SETTING: Secondary analysis of a cluster randomized trial in which patients with an LRTI were included.
METHOD: Using the characteristics of patients, their disease, and general practitioners (GPs), we conducted a multivariate logistic regression, adjusted for clustering.
RESULTS: Ninety-five out of 301 (32%) patients with low procalcitonin received antibiotics by day 28. Factors associated with an overruling of procalcitonin guidance were: a history of chest pain (adjusted OR [aOR] 1.81, 95% confidence interval 1.03-3.17); a prescription of chest X-ray by the GP (aOR 4.65, 2.32-9.34); a C-reactive protein measured retrospectively above 100 mg/L (aOR 7.48, 2.34-23.93, reference ≤ 20 mg/L); the location of the GP practice in an urban setting (aOR 2.27, 1.18-4.37); and the GP's number of years of experience (aOR per year 1.05, 1.01-1.09).
CONCLUSIONS: Overruling of procalcitonin guidance was associated with GPs' socio-demographic characteristics, pointing to the general behavioral problem of overprescription by physicians. Continuous medical education and communication training might support the successful implementation of procalcitonin point-of-care tests aimed at antibiotic stewardship.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Antibiotics (Basel, Switzerland) - 12(2023), 2 vom: 12. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Knüsli, José [VerfasserIn] |
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| Links: |
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| Themen: |
Antibiotic stewardship |
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| Anmerkungen: |
Date Revised 28.02.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.3390/antibiotics12020377 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM353364312 |
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| 100 | 1 | |a Knüsli, José |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Overruling of Procalcitonin-Guided Antibiotics for Lower Respiratory Tract Infections in Primary Care |b Ancillary Study of a Randomized Controlled Trial |
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| 520 | |a BACKGROUND: Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients with low procalcitonin at baseline received antibiotics by day 28 | ||
| 520 | |a AIM: To explore the factors associated with the overruling of initial procalcitonin guidance | ||
| 520 | |a DESIGN AND SETTING: Secondary analysis of a cluster randomized trial in which patients with an LRTI were included | ||
| 520 | |a METHOD: Using the characteristics of patients, their disease, and general practitioners (GPs), we conducted a multivariate logistic regression, adjusted for clustering | ||
| 520 | |a RESULTS: Ninety-five out of 301 (32%) patients with low procalcitonin received antibiotics by day 28. Factors associated with an overruling of procalcitonin guidance were: a history of chest pain (adjusted OR [aOR] 1.81, 95% confidence interval 1.03-3.17); a prescription of chest X-ray by the GP (aOR 4.65, 2.32-9.34); a C-reactive protein measured retrospectively above 100 mg/L (aOR 7.48, 2.34-23.93, reference ≤ 20 mg/L); the location of the GP practice in an urban setting (aOR 2.27, 1.18-4.37); and the GP's number of years of experience (aOR per year 1.05, 1.01-1.09) | ||
| 520 | |a CONCLUSIONS: Overruling of procalcitonin guidance was associated with GPs' socio-demographic characteristics, pointing to the general behavioral problem of overprescription by physicians. Continuous medical education and communication training might support the successful implementation of procalcitonin point-of-care tests aimed at antibiotic stewardship | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a antibiotic stewardship | |
| 650 | 4 | |a overruling | |
| 650 | 4 | |a primary health care | |
| 650 | 4 | |a procalcitonin | |
| 650 | 4 | |a respiratory infection | |
| 700 | 1 | |a Lhopitallier, Loïc |e verfasserin |4 aut | |
| 700 | 1 | |a Kronenberg, Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Meuwly, Jean-Yves |e verfasserin |4 aut | |
| 700 | 1 | |a Opota, Onya |e verfasserin |4 aut | |
| 700 | 1 | |a Perrenoud, Marc-Antoine |e verfasserin |4 aut | |
| 700 | 1 | |a Page, Marie-Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Kain, Kevin C |e verfasserin |4 aut | |
| 700 | 1 | |a Mamin, Aline |e verfasserin |4 aut | |
| 700 | 1 | |a D'Acremont, Valérie |e verfasserin |4 aut | |
| 700 | 1 | |a Senn, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Mueller, Yolanda |e verfasserin |4 aut | |
| 700 | 1 | |a Locatelli, Isabella |e verfasserin |4 aut | |
| 700 | 1 | |a Boillat-Blanco, Noémie |e verfasserin |4 aut | |
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