References

Al-ani S, Spigt M, Hofset P, Melbye H. Predictors of exacerbations of asthma and COPD during one year in primary care. Fam Pract. 2013; 30:(6)621-628 https://doi.org/10.1093/fampra/cmt055

Anthonisen NR, Manfreda J, Warren CPW Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987; 106:(2)196-204 https://doi.org/10.7326/0003-4819-106-2-196

Arram EO, Elrakhawy MM. Bronchiectasis in COPD patients. Egypt J Chest Dis Tuberc. 2012; 61:(4)307-312 https://doi.org/10.1016/j.ejcdt.2012.07.001

Bhowmik A, Seemungal TAR, Sapsford RJ, Wedzicha JA. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax. 2000; 55:(2)114-120 https://doi.org/10.1136/thorax.55.2.114

Brett AS, Al-Hasan MN. COPD exacerbations—a target for antibiotic stewardship. N Engl J Med. 2019; 381:(2)174-175 https://doi.org/10.1056/NEJMe1905520

Butler CC, Gillespie D, White P, Bates J, Lowe R, Thomas-Jones E, Wootton M, Hood K, Phillips R, Melbye H C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. N Engl J Med. 2019; 381:(2)111-120 https://doi.org/10.1056/NEJMoa1803185

Chen YR, Chen V, Hollander Z C-reactive protein and N-terminal prohormone brain natriuretic peptide as biomarkers in acute exacerbations of COPD leading to hospitalizations. PLoS One. 2017; 12:(3) https://doi.org/10.1371/journal.pone.0174063

Daniels JMA, Snijders D, de Graaff CS, Vlaspolder F, Jansen HM, Boersma WG. Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010; 181:(2)150-157 https://doi.org/10.1164/rccm.200906-0837OC

Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002; 57:(10)847-852 https://doi.org/10.1136/thorax.57.10.847

du Prel J-B, Röhrig B, Hommel G, Blettner M. Choosing statistical tests: part 12 of a series on evaluation of scientific publications. Dtsch Arztebl Int. 2010; 107:(19)343-348 https://doi.org/10.3238%2Farztebl.2010.0343

European Medicines Agency. The bacterial challenge—time to react. 2009. http://www.ecdc.europa.eu/en/publications-data/ecdcemea-joint-technical-report-bacterial-challenge-time-react (accessed 31 March 2022)

Francis NA, Gillespie D, White P C-reactive protein point-of-care testing for safely reducing antibiotics for acute exacerbations of chronic obstructive pulmonary disease: the PACE RCT. Health Technol Assess. 2020; 24:(15)1-108 https://doi.org/10.3310/hta24150

Gallego M, Pomares X, Capilla S, Marcos M, Suárez D, Monsó E, Montón C. C-reactive protein in outpatients with acute exacerbation of COPD: its relationship with microbial etiology and severity. Int J Chron Obstruct Pulmon Dis. 2016; 11:2633-2640 https://doi.org/10.2147/COPD.S117129

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2021 Report). 2021. https://goldcopd.org/2021-gold-reports/ (accessed 31 March 2022)

Chronic obstructive pulmonary disease hospital admissions and drugs—unexpected positive associations: a retrospective general practice cohort study. 2014. http://www.nature.com/articles/npjpcrm20146 (cited 2021 Jun 23)

Hill T, Sullivan AL, Chalmers AD British Thoracic Society Guideline for bronchiectasis in adults. Thorax. 2019; 74:1-69 https://doi.org/10.1136/thoraxjnl-2018-212463

Hurst JR, Donaldson GC, Perera WR, Wilkinson TMA, Bilello JA, Hagan GW, Vessey RS, Wedzicha JA. Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006; 174:(8)867-874 https://doi.org/10.1164/rccm.200604-506OC

Laribi S, Pemberton CJ, Kirwan L GREAT (Global Research on Acute Conditions Team) Network. Mortality and acute exacerbation of COPD: a pilot study on the influence of myocardial injury. Eur Respir J. 2017; 49:(6) https://doi.org/10.1183/13993003.00096-2017

A practical approach to using statistics in health research: from planning to reporting. 2018. https://ebookcentral.proquest.com/ (accessed 31 March 2022)

Minnaard MC, van de Pol AC, de Groot JAH The added diagnostic value of five different C-reactive protein point-of-care test devices in detecting pneumonia in primary care: A nested case-control study. Scand J Clin Lab Invest. 2015; 75:(4)291-295 https://doi.org/10.3109/00365513.2015.1006136

Miravitlles M, Moragas A, Hernández S, Bayona C, Llor C. Is it possible to identify exacerbations of mild to moderate COPD that do not require antibiotic treatment?. Chest. 2013; 144:(5)1571-1577 https://doi.org/10.1378/chest.13-0518

Musgrove MA, Kenney RM, Kendall RE, Peters M, Tibbetts R, Samuel L, Davis SL. Microbiology Comment Nudge Improves Pneumonia Prescribing. Open Forum Infect Dis. 2018; 5:(7) https://doi.org/10.1093/ofid/ofy162

National Institute for Health and Care Excellence. Briefing Paper. Quality standard topic: Chronic obstructive pulmonary disease (COPD) update. 2015. http://www.nice.org.uk/guidance/qs10/ (accessed 31 March 2022)

National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing [NG114]. 2018. http://www.nice.org.uk/guidance/ng114 (accessed 31 March 2022)

National Institute for Health and Care Excellence. Resource impact report: Chronic obstructive pulmonary disease in over 16s: diagnosis and management (update) (NG115). 2019a. http://www.nice.org.uk/guidance/ng115/ (accessed 31 March 2022)

National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management [CG191]. 2019b. http://web.archive.org/ (accessed 31 March 2022)

National Institute for Health and Care Excellence. Pneumonia (community acquired): antimicrobial prescribing [CG191]. 2019c. http://www.nice.org.uk/guidance/NG138 (accessed 08 April 2022)

National Institute for Health and Care Excellence. Bronchiectasis: when should I suspect an infective exacerbation of bronchiectasis?. 2021. https://cks.nice.org.uk/topics/bronchiectasis/ (accessed 31 March 2022)

NHS England. Overview of potential to reduce lives lost from chronic obstructive pulmonary disease (COPD). 2014. http://www.england.nhs.uk (accessed 31 March 2022)

Ni Y, Shi G. Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: a systemic review and meta-analysis. Chest. 2016; 149:(4) https://doi.org/10.1016/j.chest.2016.02.359

Prins HJ, Duijkers R, van der Valk P, Schoorl M, Daniels JMA, van der Werf TS, Boersma WG. CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions. Eur Respir J. 2019; 53:(5) https://doi.org/10.1183/13993003.02014-2018

Public Health England. Health Matters: antimicrobial resistance. 2015. http://www.gov.uk/government/publications/ (accessed 31 March 2022)

Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2019 to 2020. 2020. https://assets.publishing.service.gov.uk (accessed 31 March 2022)

Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000; 117:(5)S398-S401 https://doi.org/10.1378/chest.117.5_suppl_2.398S

Snell N, Gibson J, Jarrold I, Quint JK. Epidemiology of bronchiectasis in the UK: findings from the British lung foundation's ‘Respiratory health of the nation’ project. Respir Med. 2019; 158:21-23 https://doi.org/10.1016/j.rmed.2019.09.012

Spriestersbach A, Röhrig B, du Prel J-B, Gerhold-Ay A, Blettner M. Descriptive statistics: the specification of statistical measures and their presentation in tables and graphs. Part 7 of a series on evaluation of scientific publications. Dtsch Arztebl Int. 2009; 106:(36)578-583 https://doi.org/10.3238/arztebl.2009.0578

Stolz D, Christ-Crain M, Gencay MM, Bingisser R, Huber PR, Müller B, Tamm M. Diagnostic value of signs, symptoms and laboratory values in lower respiratory tract infection. Swiss Med Wkly. 2006; 136:(2728)434-440

Primary Care Respiratory Society. PCRS Position Statement: Point-of-care testing of C-reactive protein (CRP) for acute assessment in COPD. 2021. http://www.pcrs-uk.org/sites/pcrs-uk.org/files/resources/2021-05-25-Position-statement-Point-of-Care-testing-for-CRP.pdf (accessed 31 March 2022)

Trappenburg JCA, van Deventer AC, Troosters T The impact of using different symptom-based exacerbation algorithms in patients with COPD. Eur Respir J. 2011; 37:(5)1260-1268 https://doi.org/10.1183/09031936.00130910

World Health Organization. DDD Indicators. 2021. http://www.who.int/tools/atc-ddd-toolkit/indicators (accessed 31 March 2022)

Ward C. Point-of-care C-reactive protein testing to optimise antibiotic use in a primary care urgent care centre setting. BMJ Open Qual. 2018; 7:(4) https://doi.org/10.1136/bmjoq-2018-000391

Wise J. COPD: spirometry does not occur in 60% of admissions, audit shows. BMJ. 2019; 365 https://doi.org/10.1136/bmj.l2141

Medicines management

Does availability of point of care C-reactive protein measurement affect provision of antibiotics in a community respiratory service?

02 May 2022
Research
02 May 2022
Volume 27 · Issue 5

Abstract

Antibiotic resistance presents a growing threat to health systems and patients at a global scale. Point of care (POC) C-reactive protein (CRP) measurement, as an adjunct to exacerbation assessment, has been studied in primary and secondary care and may represent a useful tool for community teams. A retrospective service review was conducted to determine the effect of CRP measurement on antibiotic provision in a community respiratory setting, with chronic obstructive pulmonary disease (COPD) and bronchiectasis exacerbations. This review compared antibiotic provision for COPD and bronchiectasis patients for those where CRP was measured versus those where it was not. It was found that antibiotic provision dropped by almost 25% points for COPD exacerbations, and almost 59% in bronchiectasis, when a CRP measurement was taken as a component of a respiratory assessment. Antibiotics were also provided at a greater amount based on symptom presentation. Therefore, it is concluded that CRP measurement correlates with a reduction in antibiotic provision, highlighting its use alongside symptom assessment in future work.

Resistance to antibiotics is an escalating concern, both worldwide and locally. Data from Public Health England's (PHE) 2020 English Surveillance Programme places the number of severe resistant infections at 65 162 in 2019 (equating to 178 daily new antibiotic-resistant infections a day), an increase of 7.2% from the previous year, which was a further 9% increase from the year preceding that. Across the world, mortality associated with antibiotic resistance is predicted to continue to rise (European Medicines Agency, 2009), with some estimates of costs in losses to productivity globally amounting to tens of trillions of pounds (PHE, 2015).

Between 2015-2019, antibiotic prescribing within general practice in England has declined by around 12%; however, antibiotic prescribing in community settings has increased by almost 29% over the same period when comparing defined daily doses per 1000 inhabitants per day (an estimate of the daily population proportion receiving antibiotics (World Health Organization, 2021). This is a large increase, although general practice prescribing currently accounts for 71% of all prescribing, compared to 4% within other community settings (PHE, 2020).

Register now to continue reading

Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month

Register
Or continue by

Signing in with your registered email address

Antibiotics
Bronchiectasis
COPD
CRP
Exacerbations
Respiratory