DiagNostic Study of Low-dose CT and multipleX PCR on Antibiotic Treatment and Outcome of Community-Acquired Pneumonia (CAP-NEXT)
Community-acquired Pneumonia
About this trial
This is an interventional diagnostic trial for Community-acquired Pneumonia focused on measuring Pneumonia, low-dose CT, low-dose computed tomography, point of care testing, multiplex PCR, lower respiratory tract infection, antibiotic stewardship
Eligibility Criteria
Inclusion Criteria:
- aged 18 years or above;
- working diagnosis of CAP at the emergency department with the presence of at least two clinical criteria or one clinical criterion and radiological evidence of CAP, with no other explanation for the signs and symptoms;
- requiring hospitalisation to a non-ICU ward via the ER.
Exclusion Criteria:
- Hospitalisation for two or more days in the last 14 days;
- Residence in a long-term care facility in the last 14 days;
- History of cystic fibrosis;
- Severe immunodeficiency
Sites / Locations
- Noordwest Ziekenhuisgroep
- Amphia Ziekenhuis
- Catharina Ziekenhuis
- Ter Gooi Ziekenhuis
- University Medical Center
- Maxima MC
- Langeland Ziekenhuis
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
No Intervention
Low-dose CT
PoC-PCR
Standard care
A low-dose chest CT-scan will be performed either directly from the ER or from the medical ward as soon as possible but within 24 hours of admission. The CT will be performed with a radiation dose <0.5 mSv for a 70kg patient, as a replacement or in addition to the chest radiograph. Pregnancy will be an exclusion criterion for CT because of unwanted radiation exposure. CT interpretation will be performed by a radiologist. Test results will be communicated to the treating physician. Recommendations based on the CT may be to discontinue antibiotics in case of a noninfectious diagnosis that explains the presented signs and symptoms and to start treatment for the alternative diagnosis if needed, or to re-evaluate the CAP diagnosis if no signs of lobar or bronchopneumonia are detected on the CT.
The FilmArray real-time multiplex PCR (Biofire; bioMérieux) is a Point-of-Care PCR with a panel of respiratory viruses (adenovirus, coronavirus, human metapneumovirus, human rhinovirus/enterovirus, influenza A and B, parainfluenza virus, and respiratory syncytial virus), and three atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis), which will be performed on nasopharyngeal swab samples. Test results will be made available to the treating physician immediately. The treatment recommendation could be adaptation of antibiotic treatment for a documented atypical pathogen, a recommendation to not start or discontinue antibiotics when a virus is the only detected pathogen, or a recommendation to discontinue coverage of atypical pathogens.
All hospitals will continue the antibiotic stewardship activities employed during the baseline period as part of standard care. A representative of the Antibiotics-team (Team consisting of clinical microbiologists, infectious diseases specialist and clinical pharmacists supervising in-hospital antibiotic use) will monitor the empirical antibiotic treatment of patients hospitalized with CAP to non-ICU wards and provide feedback if indicated.