C-reactive protein (C-RP) in patients with chronic heart failure (CHF) and community-acquired pneumonia (CAP): usefulness to guide antibiotic prescription

Background: Difficult diagnostics of CAP in patients with concomitant CHF often results in excessive antibiotics use. Aim: To estimate efficacy of CRP-based algorithm as a guide for antibiotic use in patients with CHF and suspected CAP. Methods: Prospective, noninferiority, observational study included adult hospitalized patients with suspected nonsevere CAP and concomitant CHF. Patients were randomized 1:1 to CRP-based algorithm (group 1) and standard care (group 2). Serum CRP cutoff value of >28.5 mg/l defined in previous study was used in group 1 to prescribe antibiotics. Group 2 was treated according to standard care. Primary end point was clinical failure at 12-14 day. Secondary ones were early clinical response (ECR) at 3-5 day and overall adverse events at 28 day: all-cause mortality, ICU admission, complications rate, recurrent CAP or CHF worsening with readmission. Standard statistical tools were used; p value <0.05 was considered significant. Results: Total 76 patients in group 1 (mean age – 74.1±9.4, 51.3% females) and 76 patients in group 2 (mean age – 75.5±10.1, 61.8% females) reached primary end point. 51 (67.1%) patients in group 1 were treated with antibiotics vs 76 (100%) - in group 2 (p<0.05). Groups were comparable (p˃0.05) regarding clinical failure (6 (7.9%) vs 7 (9.2%)), ECR (66 (86.8%) vs 68 (89.5%)), mortality (3 (3.9%) vs 2 (2.6%)), ICU admission (1 (1.3%) vs 1 (1.3%)), complications (21 (27.6%) vs 21 (27.6%)), readmission rate (5 (6.7%) vs 6 (7.9%)). Conclusion: In patients with CHF and suspected nonsevere CAP CRP-based algorithm was able to reduce antibiotics use rate without clinical outcomes worsening. Footnotes Cite this article as: European Respiratory Journal 2018 52: Suppl. 62, PA2610. This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).