現場快速C反應蛋白檢測顯著減少急性呼吸道感染患者的抗生素處方

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研究顯示，C反應蛋白（CRP）現場快速檢測（POCT）能顯著減少急性呼吸道感染患者在初診時被處方抗生素的情況。12項臨床有效性和安全性研究，包括7個隨機對照試驗（RCT）涵蓋5320名患者，發現CRP POCT組與標準護理相比，在初診時抗生素處方顯著減少（相對風險[RR] 0.76）。此結果表明CRP POCT能在一定程度上協助醫生判斷是否需要抗生素處方。

C-反應蛋白質即時檢測 (CRP POCT) 用於指導初級保健設置中急性呼吸道感染的抗生素處方。

C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections. EUnetHTA-Report

Harrington, P. and Lucey, D. and O’Brien, K. and Jordan, K. and Moran, P. and Marshall, L. and Wilbacher, I. and Gloeckner, L. (2019): C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections. EUnetHTA-Report . HTA-Projektbericht 116.

https://eprints.aihta.at/1194/

Abstract

Infection markers such as the C-reactive protein (CRP) can be used in addition to the clinical diagnosis of an infectious disease. So far, CRP tests have been carried out in the laboratory; CRP “point-of-care-testing” (POCT) refers to measurements close to the patient in primary care. The result is available within minutes. CRP POCT is intended to assist the physician to rule out a severe bacterial infection and support a decision on the need for antibiotic prescription.

Three systematic literature searches were carried out in different databases: Clinical efficacy and safety (SR1), accuracy of diagnostic tests (SR2) and analytical performance (SR3).

The systematic review of clinical efficacy and safety (SR1) included twelve studies. Seven RCTs with 5,320 patients were included in the meta-analysis for the primary endpoint of prescription (antibiotic prescription at initial consultation i.e. index consultation). The pooled estimate of the RCTs showed a statistically significant reduction in antibiotic prescription at initial consultation in the CRP POCT group compared to standard care (relative risk [RR] 0.76, 95% confidence interval [CI]: 0.67-0.86, I2= 70%). For the accuracy of the diagnostic tests (DTA) (SR2), 15 (highly heterogeneous) studies were identified concerning differences in the criteria used to define a positive test (threshold values), the diagnostic criteria (including the use of CRP values alone or as part of a clinical algorithm), the patient populations and the lack of a universal reference standard for the diagnosis of acute respiratory infections requiring antibiotics. The systematic review of analytical performance was based on 18 studies (SR3). Analytical performance describes the ability of the assay to accurately measure CRP values within an “acceptable” bias (the difference between the measured value and the true value). An acceptable bias of max 15% could be found for some tests.

Studies suggest that the use of CRP POCT leads to a statistically significant reduction in the number of patients who present themselves with acute respiratory infections in primary care and receive a prescription for an antibiotic at the initial consultation.

摘要

像C反應蛋白（CRP）這樣的感染標記可以用來輔助感染性疾病的臨床診斷。到目前為止，CRP檢測都是在實驗室進行的；CRP「即時診療測試」（POCT）指的是在基層醫療中接近病人的地方進行測量。結果在幾分鐘內就可以得出。CRP POCT旨在協助醫生排除嚴重細菌感染的可能性，並支持決定是否需要開抗生素處方。

在不同數據庫進行了三項系統性文獻搜索：臨床效能和安全性（SR1）、診斷測試的準確性（SR2）和分析性能（SR3）。

臨床效能和安全性的系統性審查（SR1）包括了十二項研究。七項隨機對照試驗（RCT）涵蓋了5,320名病人，被納入主要終點處方（即首次諮詢時的抗生素處方）的統合分析中。RCT的合併估計顯示，與標準護理相比，CRP POCT組在首次諮詢時的抗生素處方顯著減少（相對風險[RR] 0.76，95%置信區間[CI]：0.67-0.86，I2= 70%）。對於診斷測試的準確性（DTA）（SR2），確定了15項（高度異質的）研究，這些研究涉及用於定義陽性測試的標準（閾值）、診斷標準（包括單獨使用CRP值或作為臨床算法的一部分）、患者人群，以及缺乏用於診斷需要抗生素的急性呼吸道感染的通用參考標準。分析性能的系統性審查基於18項研究（SR3）。分析性能描述了分析法準確測量CRP值的能力，這些測量值在「可接受」的偏差範圍內（測量值和真實值之間的差異）。對於某些測試，可以發現最大15％的可接受偏差。

研究表明，使用CRP POCT在基層護理中對於呈現急性呼吸道感染的患者來說，能顯著減少首次諮詢時開立抗生素處方的人數。