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Impact of comprehensive molecular testing to reduce antibiotic use in community-acquired pneumonia (RADICAP): a randomised, controlled, phase IV clinical trial protocol.
Abelenda-Alonso, Gabriela; Rombauts, Alexander; Gudiol, Carlota; Meije, Yolanda; Clemente, Mercedes; Ortega, Lucía; Ardanuy, Carmen; Niubó, Jordi; Padullés, Ariadna; Videla, Sebastian; Tebe, Cristian; Carratalà, Jordi.
Afiliación
  • Abelenda-Alonso G; Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain gabi.abelenda.alonso@gmail.com.
  • Rombauts A; Bellvitge Institute for Biomedical Research, Barcelona, Spain.
  • Gudiol C; Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
  • Meije Y; Statistics Advisory Service, Institut d\'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain.
  • Clemente M; Infectious Diseases, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
  • Ortega L; University of Barcelona, Barcelona, Catalunya, Spain.
  • Ardanuy C; Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain.
  • Niubó J; Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain.
  • Padullés A; Infectious Diseases Unit-Department of Internal Medicine, Hospital de Barcelona, Barcelona, Catalunya, Spain.
  • Videla S; Department of Clinical Microbiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
  • Tebe C; Department of Clinical Microbiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
  • Carratalà J; Department of Farmacology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
BMJ Open ; 10(8): e038957, 2020 08 20.
Article en En | MEDLINE | ID: mdl-32819999
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neumonía / COVID-19 Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline Aspecto: Ethics Límite: Adult / Humans Idioma: En Revista: BMJ Open Año: 2020 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neumonía / COVID-19 Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline Aspecto: Ethics Límite: Adult / Humans Idioma: En Revista: BMJ Open Año: 2020 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido