Abstract：
Testing serum C-reactive protein (CRP) levels can help determine whether there is a need for antibiotics and can limit prescribing of antibiotics for illnesses that are likely viral or non-infectious in origin. Using Health Search, an Italian primary care database, we identified all patients, aged 15 years or older, being registered in the period between 1 January 2000 and 31 December 2019 and newly diagnosed with upper respiratory tract infections (URTIs) or COPD- or asthma-related exacerbations. From the date of these diagnoses, patients were followed up until occurrence of antibiotic prescription (for these indications) up to 31 December 2019. The association between the CRP testing and the outcome was investigated using a nested case-control analysis. In a cohort of 469 684 patients being diagnosed for URTI (83%), COPD- (11%) and asthma (7%)-related exacerbations, 28 688 (6.11%) were prescribed with antibiotics because of the aforementioned indications. Of note, 98% of cases, nominally those prescribed with antibiotics, were not tested with CRP. However, those receiving antibiotics were more likely to have been previously tested for CRP than controls who did not receive antibiotics (833/28 601 [3%] and 4128/277 968 [1.5%]; OR 2.0 [95% CI: 1.8-2.1]). Our findings indicate that most of the antibiotic prescriptions for the investigated conditions were given without any prior CRP testing. A small minority of GPs did properly use CRP to determine whether antibiotics were needed. Further guidance is needed in Italy on the use of CRP in guiding antibiotic prescribing in primary care.
摘要：
测试血清C反应蛋白（CRP）水平可以帮助确定是否需要抗生素，并可以限制抗生素的处方可能是病毒性或非感染性的疾病。使用运行状况搜索，意大利初级保健数据库,我们确定了所有的病人,15岁或以上，在2000年1月1日至2019年12月31日期间注册，并且新诊断为上呼吸道感染（URTI）或COPD或哮喘相关急性加重。从这些诊断之日起，对患者进行随访,直至出现抗生素处方(针对这些适应症),直至2019年12月31日.使用嵌套病例对照分析研究了CRP测试与结果之间的关联。在469684名被诊断为URTI的患者（83％）中，与COPD（11%）和哮喘（7%）相关的恶化，由于上述适应症，有28688（6.11％）开了抗生素。值得注意的是，98%的病例,名义上那些用抗生素开的处方，没有用CRP测试。然而,与未接受抗生素治疗的对照组相比,接受抗生素治疗的患者以前接受过CRP检测的可能性更高(833/28601[3%]和4128/277968[1.5%];OR2.0[95%CI:1.8~2.1]).我们的发现表明，针对所研究条件的大多数抗生素处方都是在没有任何CRP测试的情况下给出的。少数全科医生正确使用CRP来确定是否需要抗生素。意大利需要进一步指导CRP在指导初级保健抗生素处方中的使用。
