Dr Rogier Hopstaken | A Simple Point-of-Care Test to Combat Antibiotic Resistance

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Dr Rogier Hopstaken | A Simple Point-of-Care Test to Combat Antibiotic Resistance

Feb 7, 2024 | health and medicine

About this episode

While antibiotics are an essential tool for treating disease, their effectiveness in preventing severe illness and death is under threat. Antibiotic resistance is now one of the biggest dangers to global health. When a bacterial infection is treated with antibiotics, certain bacteria in a patient may hold genetic mutations that allow them to evade destruction. These resistant bacteria can become more severe and spread further, requiring stronger antibiotics or potentially leading to the patient’s death. Around 5 million deaths were related to antibiotic resistance in 2019 alone, and cases are predicted to rise.

One contributing factor to antibiotic resistance is the extensive over-prescription of antibiotics to patients, particularly for respiratory infections. However, 70–80% of these infections are not severe and are often viral, and should not be treated with antibiotics. Those patients will recover without treatment – and may even be harmed by antibiotics.

Dr Rogier Hopstaken, a general practitioner and researcher from the Netherlands, has shown that a simple yet effective technique may be the answer to antibiotic over-prescription. This technique is called C-reactive protein point-of-care testing, which assesses blood levels of a protein produced by the liver in response to inflammation.

This test can be used in primary care settings, such as a physician’s clinic, to indicate within 3 minutes whether a patient with a respiratory illness has a severe bacterial infection and requires antibiotics.

Dr Hopstaken and his team have shown that C-reactive protein is by far the best predictor of pneumonia, performing much better than any symptom or sign, and better than the combination of all symptoms and signs.

In two studies involving patients with respiratory infections, his team demonstrated that the use of this test led to a 30% reduction in unnecessary antibiotic prescriptions. Improving communication skills added considerably to this effect.

Dr Hopstaken wants to improve the diagnostic and communication skills of physicians, so that more patients with pneumonia get the antibiotics they need, while antibiotics can be safely withheld from those with minor illnesses. To achieve this, he argues that a support model must also be created for physicians to facilitate integration and to ensure the quality of testing. Finally, he believes that funding for the test equipment should be seen as a wider investment in better, cost-effective healthcare.

Although C-reactive protein point-of-care testing and better communication will play an important role in reducing antibiotic resistance, it should be seen as one intervention in a multi-step process. Dr Hopstaken has shown that this type of antibiotic stewardship could pave the way to finally addressing antibiotic resistance, starting with primary care where most antibiotics are prescribed, and then beyond.

Original Article Reference

Summary of the papers:

Implementing point-of-care CRP testing for better diagnosis of acute respiratory infections, doi.org/10.3399/bjgp22X718517

Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: cluster randomised controlled trial, doi.org/10.1136/bmj.n2198

Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial, doi.org/10.1370/afm.1090

Effect of point of care testing for C-reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial, doi.org/10.1136/bmj.b1374

Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection, PMID: 12830562; PMCID: PMC1314594

Guidance on C-reactive protein point-of-care testing and complementary strategies to improve antibiotic prescribing for adults with lower respiratory tract infections in primary care, doi.org/10.3389/fmed.2023.1166742