Evaluating the evidence for the implementation of C-reactive protein measurement in adult patients with suspected lower respiratory tract infection in primary care: a systematic review

Abstract Background: Whether procalcitonin (PCT) or C-reactive protein (CRP) combined with some clinical characteristics can better distinguish viral from bacterial infection is not clear. The aim was to assess the ability of PCT or CRP combined with clinical characteristics to distinguish between viral and bacterial infections in hospitalized non-intensive care unit (ICU) adults with lower respiratory tract infection (LRTI).Methods: This was a post-hoc analysis of a randomized clinical trial previously conducted among LRTI patients. The ability of PCT, CRP, and PCT or CRP combined with clinical characteristics to discriminate between viral and bacterial infection were estimated by portraying receiver operating characteristic (ROC) curves among patients with only vial or typical bacterial infection .Results: In total, 209 patients (virus 69%, bacteria 31%) were included in this study. When using CRP or PCT to discriminate between viral and bacterial LRTI, the optimal cut-off point were 22mg/L and 0.18ng/ml, respectively. When the optimal cut-off for CRP (≤22ml/L) or PCT (≤0.18ng/ml) combined with rhinorrhea was used to discriminate viral from bacterial LRTI, the AUCs were 0.81 (95% CI, 0.75–0.87) and 0.80 (95% CI, 0.74–0.86), respectively. When CRP≤22ml/L, PCT≤0.18ng/ml and rhinorrhea were combined, the AUC was 0.86 (95% CI, 0.80–0.91), which was statistically significant higher than that when CRP(≤22mg/L) or PCT (≤0.18ng/mL) was combined with rhinorrhea (p=0.0107 and p=0.0205).Conclusions: Either CRP≤22mg/L or PCT≤0.18ng/mL combined with rhinorrhea could help distinguish viral from bacterial infection in hospitalized non-ICU adults with LRTI. When rhinorrhea was combined together, discrimination ability can be further improved.

Download Full-text

Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection

The Pediatric Infectious Disease Journal ◽

10.1097/01.inf.0000095197.72976.4f ◽

2003 ◽

Vol 22 (11) ◽

pp. 963-967 ◽

Cited By ~ 71

Author(s):

CRISTINA PRAT ◽

JOSEP DOM??NGUEZ ◽

CARLOS RODRIGO ◽

MONTSE GIM??NEZ ◽

MARTA AZUARA ◽

...

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Leukocyte Count ◽

C Reactive Protein ◽

Reactive Protein

Download Full-text

Funding and policy incentives to encourage implementation of point-of-care C-reactive protein testing for lower respiratory tract infection in NHS primary care: a mixed-methods evaluation

BMJ Open ◽

10.1136/bmjopen-2018-024558 ◽

2018 ◽

Vol 8 (10) ◽

pp. e024558 ◽

Cited By ~ 4

Author(s):

Matthew Johnson ◽

Liz Cross ◽

Nick Sandison ◽

Jamie Stevenson ◽

Thomas Monks ◽

...

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Point Of Care ◽

Implementation Study ◽

C Reactive Protein ◽

Reactive Protein

ObjectivesUtilisation of point-of-care C-reactive protein testing for lower respiratory tract infection has been limited in UK primary care, with costs and funding suggested as important barriers. We aimed to use existing National Health Service funding and policy mechanisms to alleviate these barriers and engage with clinicians and healthcare commissioners to encourage implementation.DesignA mixed-methods study design was adopted, including a qualitative survey to identify clinicians’ and commissioners’ perceived benefits, barriers and enablers post-implementation, and quantitative analysis of results from a real-world implementation study.InterventionsWe developed a funding specification to underpin local reimbursement of general practices for test delivery based on an item of service payment. We also created training and administrative materials to facilitate implementation by reducing organisational burden. The implementation study provided intervention sites with a testing device and supplies, training and practical assistance.ResultsDespite engagement with several groups, implementation and uptake of our funding specification were limited. Survey respondents confirmed costs and funding as important barriers in addition to physical and operational constraints and cited training and the value of a local champion as enablers.ConclusionsAlthough survey respondents highlighted the clinical benefits, funding remains a barrier to implementation in UK primary care and appears not to be alleviated by the existing financial incentives available to commissioners. The potential to meet incentive targets using lower cost methods, a lack of policy consistency or competing financial pressures and commissioning programmes may be important determinants of local priorities. An implementation champion could help to catalyse support and overcome operational barriers at the local level, but widespread implementation is likely to require national policy change. Successful implementation may reproduce antibiotic prescribing reductions observed in research studies.

Download Full-text