A Procalcitonin and C-Reactive Protein-Guided Clinical Pathway for Reducing Antibiotic Use in Children Hospitalized with Bronchiolitis

Despite the lack of evidence that bronchodilators, corticosteroids, and antibiotics are useful in treating bronchiolitis, their use is still widespread. This study aimed to determine the consumption of antibiotics for bronchiolitis before and after a procalcitonin-guided clinical pathway (CP) implementation. In December 2019, a CP for lower respiratory tract infection management was implemented at the Department of Women’s and Children’s Health at Padua University Hospital. This was a pre-post, quasi-experimental study that assessed the changes in the treatment of bronchiolitis during two bimesters preceding the CP implementation (pre-period: January 2018–February 2018 and January 2019–February 2019) and during the bimester after CP implementation (post-period January 2020–February 2020). After the CP implementation, there was a significant reduction in antibiotic prescriptions from 36.2% to 12.5% (p = 0.036) in patients hospitalized for bronchiolitis. Co-amoxiclav treatment, the antibiotic most commonly administered, decreased from 66.6% to 33.3%. Among outpatients’ bronchiolitis episodes, a statistically significant decrease in beta2-agonists’ use (from 18.0% to 4.4%, pre and post periods) and a quasi-significant decrease in corticosteroid use (from 8.0% to 0% pre and post periods) were observed. An evidence-based CP supported by educational lectures was associated with significant changes in the physicians’ prescribing habits.

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Faculty Opinions recommendation of Safety and efficacy of C-reactive protein-guided antibiotic use to treat acute respiratory infections in Tanzanian children: a planned subgroup analysis of a randomized, controlled non-inferiority trial evaluating a novel electronic clinical decision algorithm (ePOCT).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735024057.793560941 ◽

2019 ◽

Author(s):

Thomas Althaus

Keyword(s):

Subgroup Analysis ◽

Respiratory Infections ◽

Clinical Decision ◽

Antibiotic Use ◽

Acute Respiratory Infections ◽

C Reactive Protein ◽

Decision Algorithm ◽

Safety And Efficacy ◽

Reactive Protein ◽

Randomized Controlled

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Implementation of C-reactive protein point of care testing to improve antibiotic targeting in respiratory illness in Vietnamese primary care (ICAT): a study protocol for a cluster randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-040977 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040977

Author(s):

Nga Thi Thuy Do ◽

Rachel Claire Greer ◽

Yoel Lubell ◽

Sabine Dittrich ◽

Maida Vandendorpe ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Prescription ◽

Point Of Care ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Antibiotic Use ◽

Routine Care ◽

C Reactive Protein ◽

Reactive Protein ◽

Randomised Controlled

IntroductionC-reactive protein (CRP), a biomarker of infection, has been used widely in high-income settings to guide antibiotic treatment in patients presenting with respiratory illnesses in primary care. Recent trials in low- and middle-income countries showed that CRP testing could safely reduce antibiotic use in patients with non-severe acute respiratory infections (ARIs) and fever in primary care. The studies, however, were conducted in a research-oriented context, with research staff closely monitoring healthcare behaviour thus potentially influencing healthcare workers’ prescribing practices. For policy-makers to consider wide-scale roll-out, a pragmatic implementation study of the impact of CRP point of care (POC) testing in routine care is needed.Methods and analysisA pragmatic, cluster-randomised controlled trial, with two study arms, consisting of 24 commune health centres (CHC) in the intervention arm (provision of CRP tests with additional healthcare worker guidance) and 24 facilities acting as controls (routine care). Comparison between the treatment arms will be through logistic regression, with the treatment assignment as a fixed effect, and the CHC as a random effect. With 48 clusters, an average of 10 consultations per facility per week will result in approximately 520 over 1 year, and 24 960 in total (12 480 per arm). We will be able to detect a reduction of 12% to 23% or more in immediate antibiotic prescription as a result of the CRP POC intervention. The primary endpoint is the proportion of patient consultations for ARI resulting in immediate antibiotic prescription. Secondary endpoints include the proportion of all patients receiving an antibiotic prescription regardless of ARI diagnosis, frequency of re-consultation, subsequent antibiotic use when antibiotics are not prescribed, referral and hospitalisation.Ethics and disseminationThe study protocol was approved by the Oxford University Tropical Research Ethics Committee (OxTREC, Reference: 53–18), and the ethical committee of the National Hospital for Tropical Diseases in Vietnam (Reference:07/HDDD-NDTW/2019). Results from this study will be disseminated via meetings with stakeholders, conferences and publications in peer-reviewed journals. Authorship and reporting of this work will follow international guidelines.Trial registration detailsNCT03855215; Pre-results.

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Chronic Induction of C-Reactive Protein by Hemodialysis, but Not by Peritoneal Dialysis Therapy

Peritoneal Dialysis International ◽

10.1177/089686089601600213 ◽

1996 ◽

Vol 16 (2) ◽

pp. 158-162 ◽

Cited By ~ 65

Author(s):

Marion Haubitz ◽

Reinhard Brunkhorst ◽

Eike Wrenger ◽

Peter Froese ◽

Matthias Schulze ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Insufficiency ◽

Chronic Renal Insufficiency ◽

Inflammatory Activity ◽

C Reactive Protein ◽

Dialysis Therapy ◽

Dialysis Treatment ◽

Reactive Protein ◽

Before And After ◽

Patient Groups

Objective Evaluation of the inflammatory activity in patients on chronic peritoneal dialysis (PD) and patients on chronic hemodialysis (HD) in comparison to patients with chronic renal insufficiency without dialysis treatment and healthy volunteers. Design Open, non randomized prospective study. Setting Nephrology Department, including HD and PD therapy in a university hospital. Patients Twenty -four patients on chronic PD, 21 patients on chronic HD therapy using a cuprophan dialyzer, 16 patients with chronic renal insufficiency without dialysis treatment, and 33 healthy volunteers; 8 additional patients before and after initiation of chronic HD therapy. All patients and controls were without infection or immunosuppressive therapy. Main Outcome Measures As a marker of the inflammatory activity in the different patient groups, C-reactive protein (CAP) was measured serially using a sensitive, enzyme-Iinked, immunosorbent assay in order to detect values below the detection limit of standard assays. Results All patient groups had CAP levels higher than the normal controls (p < 0.01). Patients on HD had CAP levels significantly higher than PD patients (p < 0.01) whose levels were comparable to patients without dialysis therapy. Accordingly, longitudinal measurements before and after initiation of chronic HD showed a significant increase in CAP levels after the beginning of HD treatment (p < 0.04). Conclusions The results suggest that induction of the inflammatory activity is lower during PD compared to HD, since stimulation by the dialyzer membrane, dialysate buffer, or bacterial fragments in the dialysate is avoided. This observation might indicate a possible lower risk of long-term complications in patients with PD.

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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

Family Practice ◽

10.1093/fampra/cmr119 ◽

2011 ◽

Vol 29 (4) ◽

pp. 383-393 ◽

Cited By ~ 33

Author(s):

M. F. Engel ◽

F. P. Paling ◽

A. I. M. Hoepelman ◽

V. van der Meer ◽

J. J. Oosterheert

Keyword(s):

Systematic Review ◽

Primary Care ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

C Reactive Protein ◽

Reactive Protein ◽

Protein Measurement

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Concentrations of the acute phase reactants high-sensitive C-reactive protein and YKL-40 and of interleukin-6 before and after treatment in patients with acromegaly and growth hormone deficiency

Clinical Endocrinology ◽

10.1111/j.1365-2265.2007.02986.x ◽

2007 ◽

Vol 67 (6) ◽

pp. 909-916 ◽

Cited By ~ 13

Author(s):

Mikkel Andreassen ◽

Henrik Vestergaard ◽

Lars Østergaard Kristensen

Keyword(s):

Growth Hormone ◽

Growth Hormone Deficiency ◽

Acute Phase ◽

Interleukin 6 ◽

Hormone Deficiency ◽

C Reactive Protein ◽

Acute Phase Reactants ◽

Reactive Protein ◽

Before And After

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Evaluation of bedbath in critically ill patients: impact of water temperature on the pulse oximetry variation

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-62342010000400026 ◽

2010 ◽

Vol 44 (4) ◽

pp. 1039-1045 ◽

Cited By ~ 1

Author(s):

Aretha Pereira de Oliveira ◽

Dalmo Valério Machado de Lima

Keyword(s):

Water Temperature ◽

Critically Ill ◽

Critically Ill Patients ◽

Age Groups ◽

University Hospital ◽

Convenience Sample ◽

Level Ii ◽

Before And After ◽

Quasi Experimental ◽

Water Temperature Data

This is a participant study, quasi-experimental, of a before and after type. A quantitative approach of biophysiological measures was used, represented by the saturation of oxygen measured by pulse oximeter (SpO2), and recorded on three occasions: before, during and after the bedbath in critically ill patients hospitalized at the ICU of a University Hospital in Brazil. Objective: to compare the SpO2 in various stages of the bath, with and without control of water temperature. Data collection was performed between December 2007 and April 2008 on a convenience sample consisting of 30 patients aged over 18 who had classification in TISS-28 from level II. Results show that water temperature control means a lower variation of SpO2 (p<0.05). No marked differences in variation of saturation between men and women or between age groups were established. In conclusion, heated and constant water temperature during the bedbath is able to minimize the fall of SpO2 that occurs while handling patients during procedures.

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Comparison of the Neutrophil/Lymphocyte Ratio and C-Reactive Protein Levels in Patients With Amputation for Diabetic Foot Ulcers

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734617696729 ◽

2017 ◽

Vol 16 (1) ◽

pp. 23-28 ◽

Cited By ~ 4

Author(s):

Hasan Metineren ◽

Turan Cihan Dülgeroğlu

Keyword(s):

Diabetic Foot ◽

Inflammatory Marker ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

C Reactive Protein ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Protein Levels ◽

Reactive Protein ◽

Before And After

This study compared the effectiveness of the neutrophil/lymphocyte ratio (NLR) versus C-reactive protein (CRP) for evaluating the prognosis and degree of inflammation in patients with amputation for a diabetic foot ulcer (DFU). This study enrolled 56 patients with amputations for DFU with gangrene and compared the CRP levels and NLR measured before and after surgery. Overall, 24 patients (42%) died within 2 weeks postoperatively. Mortality increased with a preoperative/postoperative CRP difference ≤1.5 ( P < .001) and age 73 years or older ( P < .001). The postoperative NLR was lower than the preoperative value but was not significant as a prognostic or inflammatory marker ( P = .945). An increasing serum CRP level is a significant predictor of mortality. CRP and old age are reliable prognostic factors in patients with DFU.

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Safety of meningococcal group B vaccination in hospitalised premature infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-314152 ◽

2018 ◽

Vol 104 (2) ◽

pp. F171-F175 ◽

Cited By ~ 6

Author(s):

Alison Kent ◽

Kazim Beebeejaun ◽

Serena Braccio ◽

Seilesh Kadambari ◽

Paul Clarke ◽

...

Keyword(s):

Adverse Events ◽

Premature Infants ◽

Antibiotic Use ◽

Neurological Status ◽

Serious Adverse Events ◽

Historical Cohort ◽

Protein Levels ◽

Reactive Protein ◽

Before And After ◽

Group B

ObjectivesTo assess the risk of significant adverse events in premature infants receiving the novel 4-component group B meningococcal vaccine (4CMenB) with their routine immunisations at 2 months of age.Participants, design and settingIn December 2015, Public Health England requested neonatal units across England to voluntarily participate in a national audit; 19 units agreed to participate. Anonymised questionnaires were completed for infants receiving 4CMenB alongside their routine immunisations. For comparison, a historical cohort of premature infants receiving their primary immunisations without 4CMenB or paracetamol prophylaxis was used.Main outcome measuresParacetamol use; temperature, cardiovascular, respiratory and neurological status before and after vaccination; and management and investigations postvaccination, including serum C reactive protein levels, infection screens and antibiotic use.ResultsComplete questionnaires were returned for 133 premature infants (<35 weeks’ gestation) who received their first dose of 4CMenB at 8 weeks of age, including 108 who received prophylactic paracetamol according to national recommendations. Overall, 7% (8/108) of infants receiving 4CMenB with paracetamol had fever (>38°C) after vaccination compared with 20% (5/25) of those receiving 4CMenB without paracetamol (P=0.06) and none of those in the historical cohort. There were no significant differences between cohorts in the proportion of infants with apnoea, bradycardia, desaturation and receiving respiratory support after vaccination.Conclusions4CMenB does not increase the risk of serious adverse events in hospitalised premature infants. This audit supports the current national recommendations to offer 4CMenB with other routine vaccinations and prophylactic paracetamol to premature infants at their chronological age.

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Childhood meningitis in the conjugate vaccine era: a prospective cohort study

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-306813 ◽

2014 ◽

Vol 100 (3) ◽

pp. 292-294 ◽

Cited By ~ 20

Author(s):

Manish Sadarangani ◽

Louise Willis ◽

Seilesh Kadambari ◽

Stuart Gormley ◽

Zoe Young ◽

...

Keyword(s):

Bacterial Meningitis ◽

Group B Streptococcus ◽

Bacterial Pathogen ◽

Antibiotic Use ◽

Viral Meningitis ◽

Older Children ◽

C Reactive Protein ◽

Blood Cell Count ◽

Reactive Protein ◽

Group B

Bacterial conjugate vaccines have dramatically changed the epidemiology of childhood meningitis; viral causes are increasingly predominant, but the current UK epidemiology is unknown. This prospective study recruited children under 16 years of age admitted to 3 UK hospitals with suspected meningitis. 70/388 children had meningitis—13 bacterial, 26 viral and 29 with no pathogen identified. Group B Streptococcus was the most common bacterial pathogen. Infants under 3 months of age with bacterial meningitis were more likely to have a reduced Glasgow Coma Score and respiratory distress than those with viral meningitis or other infections. There were no discriminatory clinical features in older children. Cerebrospinal fluid (CSF) white blood cell count and plasma C-reactive protein at all ages, and CSF protein in infants <3 months of age, distinguished between bacterial meningitis and viral meningitis or other infections. Improved diagnosis of non-bacterial meningitis is urgently needed to reduce antibiotic use and hospital stay.

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