Bedside testing for lower respiratory tract infections in nursing homes.

A cluster Randomized Controlled Trial (cRCT) will be conducted in NH organizations in the Netherlands, with the NH as the unit of randomization. NHs in the intervention group will use CRP POCT, and NHs in the control group will provide care as usual for NH residents with (suspected) LRTI.

Antibiotics are over-prescribed for lower respiratory tract infection (LRTI) in nursing home (NH) residents due to diagnostic uncertainty. Inappropriate antibiotic use is undesirable both on patient level, considering their exposure to side-effects and drug interactions, and on societal level, given the potential development of antibiotic resistance. The diagnosis of LRTI is challenging in NHs, as NH residents often lack typical symptoms, and because cognitive disabilities can impede communication of experienced complaints. ln addition, diagnostic tools are often not well-applicable or not directly available in the NH setting. C-reactive protein (CRP) point-of-care testing (POCT) may be a promising diagnostic tool to reduce unnecessary antibiotic use for LRTI in NHs.

The overarching aim of the UPCARE study is to achieve better antibiotic stewardship by introducing a cheap, quick and easy-to-use diagnostic tool for the evaluation of LRTI in NHs: CRP POCT.

During the study period (September 2018-April 2020), data collection occurs through an electronic patient file. For each diagnosis “suspected LRTI” entered by a physician in the electronic patient file, a screen will pop-up with questions about study eligibility and informed consent. In a subsequent screen the physician can fill out the research questionnaire. Follow-up information on patient recovery and changes in policy is asked one and three weeks later. In addition, pharmacy data will be collected on total antibiotic use in the NH during the study period.

A cluster randomized controlled trial (cRCT) will be conducted in NH organizations. Participating NHs will be randomized to the intervention or control group. ln the control group, care as usual is provided. ln the intervention group, physicians provide care as usual including C-Reactive Protein (CRP) Point-Of-Care-Testing (POCT) for patients who are diagnosed with 'suspected LRTl'. Elderly care physicians consider CRP POCT results along with the clinical features of the patient in their decision to prescribe or not prescribe antibiotics.