一線醫療中C反應蛋白快速檢測對抗菌藥物使用的影響：敘事性回顧

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一項文獻回顧分析顯示，C反應蛋白（CRP）快速檢測（POCT）可顯著降低抗生素處方，減少23.3%至36.16%。儘管目前沒有採用降鈣素原（procalcitonin）POCT，但在住院患者中顯示出潛在價值。醫生和患者對CRP POCT的接受度良好，經濟評估也顯示其在初級醫療中的成本效益。CRP POCT提高診斷準確性，有助於醫生更好地管理呼吸道感染（RTI）患者，並支持國家抗微生物藥物抗性策略。

初級保健中呼吸道感染（RTI）即時診療檢測（POCT）與抗菌素使用的敘述性綜述

Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI)

Jonathan Cooke 1, Christopher Butler 2, Rogier Hopstaken 3, Matthew Scott Dryden 4, Cliodna McNulty 5, Simon Hurding 6, Michael Moore 7, David Martin Livermore 8
Affiliations expand
PMID: 25973210 PMCID: PMC4426285 DOI: 10.1136/bmjresp-2015-000086

https://pubmed.ncbi.nlm.nih.gov/25973210/

Abstract

Antimicrobial resistance is a global problem and is being addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) and procalcitonin, measurements to guide antibacterial prescribing in adult patients presenting to GP practices with symptoms of respiratory tract infection (RTI). Studies that were included were randomised controlled trials, controlled before and after studies, cohort studies and economic evaluations. Many studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces antibiotic prescribing by 23.3% to 36.16%. Procalcitonin is not currently available as a point-of-care testing (POCT), but has shown value for patients with RTI admitted to hospital. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. CRP POCT can better target antibacterial prescribing by GPs and contribute to national antimicrobial resistance strategies. Health services need to develop ways to ensure funding is transferred in order for POCT to be implemented.

Keywords: Bacterial Infection; Pneumonia; Respiratory Infection.

摘要

抗微生物藥物抗性是一個全球性問題，正通過國家戰略來解決，以改進診斷、開發新的抗微生物藥物和促進抗微生物藥物管理。進行了一項敘述性文獻綜述，以確定C反應蛋白（CRP）和降鈣素原測量指導成人患者在全科醫生診所呈現呼吸道感染（RTI）症狀時抗菌素處方的價值。納入的研究包括隨機對照試驗、對照前後研究、隊列研究和經濟

評估。許多研究表明，在出現RTI症狀的患者中使用CRP測試可以減少抗生素處方23.3%至36.16%。降鈣素原目前尚不可作為即時診療測試（POCT）使用，但對於入院治療的RTI患者已顯示出價值。全科醫生和患者對CRP POCT表示良好的接受度，經濟評估顯示CRP POCT在初級保健中現有RTI管理方面具有成本效益。POCT提高了全科醫生在更好地管理RTI患者方面的診斷精確性。CRP POCT可以使全科醫生的抗菌素處方更有針對性，並有助於國家抗微生物藥物抗性戰略。衛生服務機構需要制定方法，確保資金轉移以便實施POCT。

關鍵詞：細菌感染；肺炎；呼吸道感染。

圖1

來自Cochrane綜述《生物標記物作為即時診療測試以指導基層醫療中急性呼吸道感染患者抗生素處方的隨機和群體隨機對照試驗的森林圖》。

圖2

2012年歐洲聯盟/歐洲經濟區國家社區中系統使用抗菌劑（ATC組J01）的消耗量，按解剖治療化學（ATC）組別3級別表示，以每千居民每天定義日劑量（DDD）計算。資料來源：歐洲疾病預防與控制中心。

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