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Abelenda-Alonso G, Rombauts A, Gudiol C, Meije Y, Clemente M, Ortega L, Ardanuy C, Niubó J, Padullés A, Videla S, Tebe C, Carratalà J. Impact of comprehensive molecular testing to reduce antibiotic use in community-acquired pneumonia (RADICAP): a randomised, controlled, phase IV clinical trial protocol. BMJ Open 2020; 10:e038957. [PMID: 32819999 PMCID: PMC7443276 DOI: 10.1136/bmjopen-2020-038957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) continues to be a major health problem worldwide and is one of the main reasons for prescribing antibiotics. However, the causative agent is often not identified, resulting in antibiotic overtreatment, which is a key driver of antimicrobial resistance and adverse events. We aim to test the hypothesis that comprehensive molecular testing, compared with routine microbiological testing, would be effective in reducing antibiotic use in patients with CAP. METHODS AND ANALYSIS We will perform a randomised, controlled, open-label clinical trial with two parallel groups (1:1) at two tertiary hospitals between 2020 and 2022. Non-severely immunosuppressed adults hospitalised for CAP will be considered eligible. Patients will be randomly assigned to receive either the experimental diagnosis (comprehensive molecular testing plus routine microbiological testing) or standard diagnosis (only microbiological routine testing). The primary endpoint will be antibiotic consumption measured as days of antibiotic therapy per 1000 patient-days. Secondary endpoints will be de-escalation to narrower antibiotic treatment, time to switch from intravenous to oral antibiotics, days to reaching an aetiological diagnosis, antibiotic-related side effects, length of stay, days to clinical stability, intensive care unit admission, days of mechanical ventilation, hospital readmission up to 30 days after randomisation and death from any cause by 48 hours and 30 days after randomisation. We will need to include 440 subjects to be able to reject the null hypothesis that both groups have equal days of antibiotic therapy per 1000 patient-days with a probability >0.8. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Bellvitge Hospital (AC028/19) and from the Spanish Medicines and Medical Devices Agency, and it is valid for all participating centres under existing Spanish legislation. Results will be presented at international meetings and will be made available to patients, their caregivers and funders. TRIAL REGISTRATION NUMBER ClinicalTrials: NCT04158492. EudraCT: 2018-004880-29.
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Affiliation(s)
- Gabriela Abelenda-Alonso
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Institute for Biomedical Research, Barcelona, Spain
| | - Alexander Rombauts
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Statistics Advisory Service, Institut d\'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carlota Gudiol
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Catalunya, Spain
| | - Yolanda Meije
- Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain
| | - Mercedes Clemente
- Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain
| | - Lucía Ortega
- Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain
| | - Carmen Ardanuy
- Department of Clinical Microbiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Niubó
- Department of Clinical Microbiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ariadna Padullés
- Department of Farmacology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastian Videla
- Department of Clinical Farmacology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebe
- Statistics Advisory Service, Institut d\'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Jordi Carratalà
- Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Catalunya, Spain
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Zanella MC, Meylan P, Kaiser L. Syndromic panels or 'panel syndrome'? A perspective through the lens of respiratory tract infections. Clin Microbiol Infect 2020; 26:665-668. [PMID: 31904564 DOI: 10.1016/j.cmi.2019.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M-C Zanella
- Laboratory of Virology, Division of Laboratory Medicine and Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland; Laboratory of Bacteriology, Division of Laboratory Medicine and Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - P Meylan
- University of Lausanne Faculty of Biology and Medicine, Lausanne, Switzerland
| | - L Kaiser
- Laboratory of Virology, Division of Laboratory Medicine and Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
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