Sensitivity of point-of-care testing C reactive protein and procalcitonin to diagnose urinary tract infections in Dutch nursing homes: PROGRESS study protocol

Kuil, Sacha D.; Hidad, Soemeja; Fischer, Johan; Harting, Janneke; Hertogh, Cees M.P.M.; Prins, Jan M.; Leth, Frank van; Jong, Menno D. de; Schneeberger, Caroline

doi:10.1136/bmjopen-2019-031269

Cited by 18 publications

(23 citation statements)

References 40 publications

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“…The present study was conducted alongside the PROGRESS study (NL6293) [ 17 ], which aimed to assess the sensitivity of two inflammatory markers, CRP and PCT measured by POCT for diagnosing UTI. All three nursing home organizations that took part in the PROGESS study also agreed to participate in the present interview study.…”

Section: Methodsmentioning

confidence: 99%

“…Diagnostic tests to confirm UTI in nursing home residents are not yet available. Our current research focuses on the sensitivity of two blood inflammatory markers (C-reactive protein [CRP] and procalcitonin [PCT]), measured in point-of-care testing (POCT) to support diagnosing UTI [ 17 ]. Provided the sensitivity of such POCT is sufficient, it can be used in the clinical work-up to confirm the UTI diagnosis in nursing home residents, provided that the positive predictive value is sufficient in that population.…”

Section: Introductionmentioning

confidence: 99%

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“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

et al. 2020

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Background Diagnosing urinary tract infections (UTI) in nursing home residents is complex, due to frequent non-specific symptomatology and asymptomatic bacteriuria. The objective of this study was to explore health care professionals’ perceptions of the proposed use of inflammatory marker Point-Of-Care Testing (POCT) in this respect. Methods We conducted a qualitative inquiry (2018–2019) alongside the multicenter PROGRESS study (NL6293), which assessed the sensitivity of C-reactive protein and procalcitonin POCT in UTI. We used semi-structured face-to-face interviews. The participants were physicians (n = 12) and nurses (n = 6) from 13 nursing homes in the Netherlands. Most respondents were not familiar with inflammatory marker POCT, while some used POCT for respiratory tract infections. Both the interview guide and the analysis of the interview transcripts were based on the Consolidated Framework for Implementation Research. Results All respondents acknowledged that sufficiently sensitive POCT could decrease diagnostic uncertainty to some extent in residents presenting with non-specific symptoms. They primarily thought that negative test results would rule out UTI and justify withholding antibiotic treatment. Secondly, they described how positive test results could rule in UTI and justify antimicrobial treatment. However, most respondents also expected new diagnostic uncertainties to arise. Firstly, in case of negative test results, they were not sure how to deal with residents’ persisting non-specific symptoms. Secondly, in case of positive test results, they feared overlooking infections other than UTI. These new uncertainties could lead to inappropriate antibiotics use. Therefore, POCT was thought to create a false sense of confidence. Conclusions Our study suggests that inflammatory marker POCT will only improve UTI management in nursing homes to some extent. To realize the expected added value, any implementation of POCT requires thorough guidance to ensure appropriate use. Developing UTI markers with high negative and positive predictive values may offer greater potential to improve UTI management in nursing homes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The present study was conducted alongside the PROGRESS study (NL6293) [17], which aimed to assess the sensitivity of two in ammatory markers, CRP and PCT measured by POCT for diagnosing UTI. All three nursing home organizations that took part in the PROGESS study also agreed to participate in the present interview study.…”

Section: Settingmentioning

confidence: 99%

“…Diagnostic tests to con rm UTI in nursing home residents are not yet available. Our current research focuses on the sensitivity of two blood in ammatory markers (C-reactive protein [CRP] and procalcitonin [PCT]), measured in point-of-care testing (POCT) to support diagnosing UTI [17]. Provided the sensitivity of such POCT is su cient, it can be used in the clinical work-up to con rm the UTI diagnosis in nursing home residents, provided that the positive predictive value is su cient in that population.…”

Section: Introductionmentioning

confidence: 99%

“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

Kuil

Schneeberger

Leth

et al. 2020

Preprint

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Background Diagnosing urinary tract infections (UTI) in nursing home residents is complex, due to frequent non-specific symptomatology and asymptomatic bacteriuria. The objective of this study was to explore health care professionals’ perceptions of the proposed use of inflammatory marker Point-Of-Care Testing (POCT) in this respect. Methods We conducted a qualitative inquiry (2018 - 2019) alongside the multicenter PROGRESS study (NL6293), which assessed the sensitivity of C-reactive protein and procalcitonin POCT in UTI. We used semi-structured face-to-face interviews. The participants were physicians (n=12) and nurses (n=6) from 13 nursing homes in the Netherlands. Most respondents were not familiar with inflammatory marker POCT, while some used POCT for respiratory tract infections. Both the interview guide and the analysis of the interview transcripts were based on the Consolidated Framework for Implementation Research. Results All respondents acknowledged that sufficiently sensitive POCT could decrease diagnostic uncertainty to some extent in residents presenting with non-specific symptoms. They primarily thought that negative test results would rule out UTI and justify withholding antibiotic treatment. Secondly, they described how positive test results could rule in UTI and justify antimicrobial treatment. However, most respondents also expected new diagnostic uncertainties to arise. Firstly, in case of negative test results, they were not sure how to deal with residents’ persisting non-specific symptoms. Secondly, in case of positive test results, they feared overlooking infections other than UTI. These new uncertainties could lead to inappropriate antibiotics use. Therefore, POCT was thought to create a false sense of confidence. Conclusions Our study suggests that inflammatory marker POCT will only improve UTI management in nursing homes to some extent. To realize the expected added value, any implementation of POCT requires thorough guidance to ensure appropriate use. Developing UTI markers with high negative and positive predictive values may offer greater potential to improve UTI management in nursing homes.

show abstract

“…Our current research focuses on the sensitivity of two blood in ammatory markers (C-reactive protein [CRP] and procalcitonin [PCT]), measured in point-of-care testing (POCT) to support diagnosing UTI. [17] Provided the sensitivity of such POCT is su cient, it can be used in the clinical work-up to con rm the UTI diagnosis in nursing home residents, provided that the positive predictive value is su cient in that population. This would enable residents with true UTI to be identi ed, potentially improving the appropriate use of antibiotics, and consequently reducing unnecessary side-effects and antimicrobial resistance.…”

Section: Introductionmentioning

confidence: 99%

“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

Kuil

Schneeberger

Leth

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Diagnosing urinary tract infections (UTI) in nursing home residents is complex, due to frequent non-specific symptomatology and asymptomatic bacteriuria. The objective of this study was to explore health care professionals’ perceptions of the proposed use of inflammatory marker Point-Of-Care Testing (POCT) in this respect. Methods We conducted a qualitative inquiry (2018 - 2019) alongside the multicenter PROGRESS study (NL6293), which assessed the sensitivity of C-reactive protein and procalcitonin POCT in UTI. We used semi-structured face-to-face interviews. The participants were physicians (n=12) and nurses (n=6) from 13 nursing homes in the Netherlands. Most respondents were not familiar with inflammatory marker POCT, while some used POCT for respiratory tract infections. Both the interview guide and the analysis of the interview transcripts were based on the Consolidated Framework for Implementation Research. Results All respondents acknowledged that sufficiently sensitive POCT could decrease diagnostic uncertainty to some extent in residents presenting with non-specific symptoms. They primarily thought that negative test results would rule out UTI and justify withholding antibiotic treatment. Secondly, they described how positive test results could rule in UTI and justify antimicrobial treatment. However, most respondents also expected new diagnostic uncertainties to arise. Firstly, in case of negative test results, they were not sure how to deal with residents’ persisting non-specific symptoms. Secondly, in case of positive test results, they feared overlooking infections other than UTI. These new uncertainties could lead to inappropriate antibiotics use. Therefore, POCT was thought to create a false sense of confidence. Conclusions Our study suggests that inflammatory marker POCT will only improve UTI management in nursing homes to some extent. To realize the expected added value, any implementation of POCT requires thorough guidance to ensure appropriate use. Developing UTI markers with high negative and positive predictive values may offer greater potential to improve UTI management in nursing homes.

show abstract

Sensitivity of point-of-care testing C reactive protein and procalcitonin to diagnose urinary tract infections in Dutch nursing homes: PROGRESS study protocol

Cited by 18 publications

References 40 publications

“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

“A false sense of confidence” The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

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