C-reactive protein testing to reduce antibiotic prescribing for acute respiratory infections in adults: a systematic review and meta-analysis.
C-reactive protein testing to reduce antibiotic prescribing for acute respiratory infections in adults: a systematic review and meta-analysis.
复制标题
C反应蛋白检测可减少成人急性呼吸道感染的抗生素处方：系统评价和荟萃分析
DOI：
10.21037/jtd-21-705
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发表时间：
2022-01
影响因子：
2.5
通讯作者：
Wang H
中科院分区：
文献类型：
--
作者：
Zhang K;Xie K;Zhang C;Liang Y;Chen Z;Wang H
背景抗菌药物耐药性（Antimicrobial resistance，AMR）已成为一个全球性的公共卫生问题。抗生素在急性呼吸道感染（ARI）中的滥用有助于增加AMR。C-反应蛋白（CRP）检测可能有助于减少抗生素过度使用，但现有证据质量差异很大。目前还没有CRP检测的荟萃分析来指导成人ARI的抗生素处方。因此，我们进行了这项荟萃分析，以确定CRP检测的有效性，以指导抗生素处方在成人ARI。方法我们检索了科克伦图书馆、PubMed和EMBASE数据库中涉及我们荟萃分析的随机对照试验（RCT），从这些数据库建立到2021年1月16日。两名评审员分别提取数据，并使用RevMan5.3合并数据。采用GRADE系统严格评价证据质量。结果7项研究共纳入3,614例患者。与常规治疗相比，CRP检测显著降低了首次会诊时的抗生素处方率[风险比（RR）=0.76; 95%置信区间（CI）：0.68-0.85; P<0.00001]，以及28天随访期间的抗生素处方率（RR =0.77; 95% CI：0.73-0.81; P<0.00001）。CRP检测组与常规护理组患者7天内临床恢复情况比较差异无统计学意义（RR =0.95，95%CI：0.90-1.01，P=0.08）。此外，CRP检测和常规护理之间的不良事件无显著差异。CRP检测可降低首次咨询时和28天随访期间的抗生素处方率。
这些发现支持CRP检测对指导成人ARI抗生素处方有价值的结论。
Background Antimicrobial resistance (AMR) has become a worldwide public health problem. Abuse of antibiotic in acute respiratory tract infections (ARI) contributes to the increasing AMR. C-reactive protein (CRP) testing may help reduce antibiotic overprescribing, but the available evidence quality varies widely. There is no meta-analysis of CRP testing to guide the antibiotic prescribing for adult ARI. Therefore, we conducted this meta-analysis to determine the effectiveness of CRP testing to guide antibiotic prescribing in adult ARI. Methods We searched the Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials (RCTs) involving our meta-analysis from the establishment of these databases until January 16, 2021. Two reviewers extracted the data separately and pooled the data using RevMan5.3. The evidence quality was appraised strictly with GRADE system. Results Seven studies included with 3,614 patients. Compared with routine care, CRP testing reduced antibiotic prescribing rate at the index consultation significantly [risk ratio (RR) =0.76; 95% confidence interval (CI): 0.68–0.85; P<0.00001], and during 28 days follow-up (RR =0.77; 95% CI: 0.73–0.81; P<0.00001). There were no significant differences between CRP testing and routine care in clinical recovery of patients within 7 days (RR =0.95; 95% CI: 0.90–1.01; P=0.08). Moreover, adverse events were not significantly different between CRP testing and routine care. Discussion CRP testing can reduce the antibiotic prescribing rate at index consultation and during 28 days
follow-up. These findings support the conclusion that CRP testing is valuable to guide the antibiotic prescribing for adult ARI.