Impact on the Use of Antibiotics of a Multimodal Algorithm for the Diagnosis and Management of Acute Community-acquired Pneumonia in the Emergency Room

Launched by ASSISTANCE PUBLIQUE - HÔPITAUX DE PARIS · Dec 10, 2022

Keywords

ClinConnect Summary

Acute community-acquired pneumonia (CAP) is the leading infectious cause of infectious death worldwide and the third leading cause of death from all causes. They are also very frequent reasons for visit to the emergency room, especially during winter season. Although respiratory viruses are responsible for approximately 30 to 50% of CAP, antibiotics' prescription remain very high. This prescription is at the origin of the phenomenon of antibiotic resistance, which continues to increase throughout the world. In the meantime, the biological testing of this clinical picture is increasingly evo...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patient 18 years or older
• • Presence of at least one respiratory sign among the following: dyspnea, cough, expectoration, auscultatory abnormalities, chest pain;
• • Presence of at least one general sign among the following: fever (T\>38°C), hypothermia (T\<35°C), myalgia, headache, asthenia;
• * Oxygen-requiring patient defined by a saturation \<95% or presenting a risk area among:
• • Age \> 65 years old
• • Alcoholic and/or tobacco intoxication
• • Congestive heart failure
• • Cerebrovascular disease (stroke or transient ischemic attack)
• • Chronic kidney disease (excluding dialysis)
• • Chronic liver disease
• • Unbalanced diabetes mellitus
• • Progressive neoplastic disease
• • Immunodepression (systemic corticosteroid therapy or immunosuppressive treatment within 6 months, splenectomy, chemotherapy within 6 months, HIV at the AIDS stage, cachexia, etc.)
• • Homozygous sickle cell disease
• • Bacterial pneumonia
• • Hospitalization during the year
• • Institutional life
• Non-inclusion Criteria:
• • Patient unable to consent: coma or acute respiratory distress requiring orotracheal intubation
• • Patient with chronic renal failure on dialysis
• • Patient with a history of chronic obstructive pulmonary disease
• • Lung transplant patient
• • Patient being treated with antibiotics at the time of the emergency room consultation
• • Patient simultaneously participating in an interventional study protocol (assessing the duration of antibiotic therapy)
• • Pregnant or breastfeeding woman
• • Patient refusal to participate
• • Patient deprived of freedom or under a legal protective measure
• • Patient under guardianship or curatorship or with cognitive impairment
• • Non-affiliation to a social security regimen or CMU
• Exclusion Criteria:
• • • RT-PCR positive for SARS-CoV-2

Trial Officials