Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2026
Clinical data, chest X-ray or C-reactive protein to initiate antibiotic therapy in outpatients with suspected community-acquired pneumonia: a prospective, randomized, controlled, digital case vignette study.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Pinot Juliette, Delory Tristan, Pétrier Mélissa, Aubin-Auger Isabelle, Whiston Marion, Issa Aïcha, Lenormand Mathieu, Partouche Henri, Gilberg Serge, Duval Xavier, Le Bel Josselin
Аннотация
OBJECTIVES: Chest X-ray (CXR) and/or C-reactive protein (CRP) could help general practitioners (GPs) distinguish community-acquired pneumonia (CAP) from other lower respiratory tract infections. This study aimed to explore whether CXR and/or CRP in clinically suspected CAP reduce antibiotic initiation by GPs.
METHODS: We conducted a prospective, randomized, controlled, digital case vignette study assigning French GPs to patients' vignette with clinically suspected CAP and (a) no further examination, (b) CXR as first-line test, (c) CRP as first-line test, or (d) CRP in addition to CXR. The primary endpoint was antibiotic initiation rate.
RESULTS: Among the 3729 included GPs (median age = 40 years [interquartile range 34-50], 66% women), 2472 GPs were assigned to 'CXR as first-line test' arm (1238 with 'CXR negative' and 1234 with 'CXR positive') of whom 71.4% (1765) initiated antibiotics as compared with 90.2% (1134) of the 1257 GPs assigned to 'no CXR' arm (21% reduction; relative risk [RR] = 0.79, 95% CI: 0.77-0.82). In the 1238 GPs with 'negative CXR', the reduction achieved 51% (RR = 0.49, 95% CI: 0.46-0.52]) as compared with no CXR. Among the 1228 GPs assigned to 'CRP as first-line test', 76.3% (937) initiated antibiotics (15% reduction in the antibiotic initiation [RR = 0.84, 95% CI: 0.81-0.87]) as compared with no CXR. Adding CRP as a reflex test to CXR systematically increased antibiotic initiation when CRP was positive and decreased it when negative.
CONCLUSIONS: In patients with clinically suspected CAP, systematic CXR as first-line test independently of its result, and to a lesser extent CRP as first-line test or as reflex test, significantly reduce antibiotic use.
METHODS: We conducted a prospective, randomized, controlled, digital case vignette study assigning French GPs to patients' vignette with clinically suspected CAP and (a) no further examination, (b) CXR as first-line test, (c) CRP as first-line test, or (d) CRP in addition to CXR. The primary endpoint was antibiotic initiation rate.
RESULTS: Among the 3729 included GPs (median age = 40 years [interquartile range 34-50], 66% women), 2472 GPs were assigned to 'CXR as first-line test' arm (1238 with 'CXR negative' and 1234 with 'CXR positive') of whom 71.4% (1765) initiated antibiotics as compared with 90.2% (1134) of the 1257 GPs assigned to 'no CXR' arm (21% reduction; relative risk [RR] = 0.79, 95% CI: 0.77-0.82). In the 1238 GPs with 'negative CXR', the reduction achieved 51% (RR = 0.49, 95% CI: 0.46-0.52]) as compared with no CXR. Among the 1228 GPs assigned to 'CRP as first-line test', 76.3% (937) initiated antibiotics (15% reduction in the antibiotic initiation [RR = 0.84, 95% CI: 0.81-0.87]) as compared with no CXR. Adding CRP as a reflex test to CXR systematically increased antibiotic initiation when CRP was positive and decreased it when negative.
CONCLUSIONS: In patients with clinically suspected CAP, systematic CXR as first-line test independently of its result, and to a lesser extent CRP as first-line test or as reflex test, significantly reduce antibiotic use.