Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care
Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care
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DOI：
10.3109/02813432.2010.506995
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发表时间：
2010-12-01
影响因子：
2.1
通讯作者：
Butler, Christopher C.
中科院分区：
文献类型：
--
作者：
Jakobsen, Kristin Alise;Melbye, Hasse;Butler, Christopher C.
客观的。呼吸道感染是初级保健中抗生素处方的最常见适应症。众所周知，下呼吸道感染（LRTI）临床发现的价值被高估了。本研究旨在确定 C 反应蛋白 (CRP) 护理点检测 (POCT) 对急性咳嗽或提示 LRTI 症状的患者开出抗生素的独立影响，以及症状和胸部检查结果如何影响何时使用或不使用该检测的处方决定。设计。成人急性咳嗽/LRTI 的表现和治疗的前瞻性观察研究。环境。挪威、瑞典和威尔士的初级保健研究网络。科目。出现急性咳嗽/LRTI 症状的成年患者应联系全科医生。主要成果衡量标准。使用逻辑回归和受试者工作特征 (ROC) 曲线分析，对接受 CRP POCT 测试的患者和未接受 CRP 测试的患者进行抗生素处方的预测因子评估。结果。三个网络总共招募了 803 名患者。在 372 名接受 CRP POCT 测试的患者中，CRP 值是抗生素处方最强的独立预测因子，CRP >= 50 mg/L 的比值比 (OR) 为 98.1。当不使用 CRP 测试时，听诊时的爆裂音和全科医生感知到的患者对抗生素的偏好是抗生素处方的最强预测因素。结论。 CRP 结果对是否开抗生素治疗急性咳嗽的决定有重大影响。当 CRP 值可用时，临床医生不太重视痰变色和肺音异常。 CRP 检测可以防止过度依赖临床特征，从而无法预测抗生素治疗的益处。
Objective. Respiratory tract infections are the most common indication for antibiotic prescribing in primary care. The value of clinical findings in lower respiratory tract infection (LRTI) is known to be overrated. This study aimed to determine the independent influence of a point of care test (POCT) for C-reactive protein (CRP) on the prescription of antibiotics in patients with acute cough or symptoms suggestive of LRTI, and how symptoms and chest findings influence the decision to prescribe when the test is and is not used. Design. Prospective observational study of presentation and management of acute cough/LRTI in adults. Setting. Primary care research networks in Norway, Sweden, and Wales. Subjects. Adult patients contacting their GP with symptoms of acute cough/LRTI. Main outcome measures. Predictors of antibiotic prescribing were evaluated in those tested and those not tested with a POCT for CRP using logistic regression and receiver operating characteristic (ROC) curve analysis. Results. A total of 803 patients were recruited in the three networks. Among the 372 patients tested with a POCT for CRP, the CRP value was the strongest independent predictor of antibiotic prescribing, with an odds ratio (OR) of CRP >= 50 mg/L of 98.1. Crackles on auscultation and a patient preference for antibiotics perceived by the GP were the strongest predictors of antibiotic prescribing when the CRP test was not used. Conclusions. The CRP result is a major influence in the decision whether or not to prescribe antibiotics for acute cough. Clinicians attach less weight to discoloured sputum and abnormal lung sounds when a CRP value is available. CRP testing could prevent undue reliance on clinical features that poorly predict benefit from antibiotic treatment.