CAPNOR
Trial question
What is the role of rapid syndromic molecular panel testing in patients with suspected community-acquired pneumonia?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 374
374 patients (153 female, 221 male).
Inclusion criteria: adult patients presenting to the emergency department with suspected community-acquired pneumonia.
Key exclusion criteria: cystic fibrosis; severe bronchiectasis; hospitalization within the past 14 days prior to admission; life expectancy of < 2 weeks.
Interventions
N=187 syndromic molecular testing (standard of care diagnostics plus rapid syndromic molecular panel testing).
N=187 standard of care (standard of care diagnostics).
Primary outcome
Provision of pathogen-directed treatment
35.3%
13.4%
35.3 %
26.5 %
17.6 %
8.8 %
0.0 %
Syndromic molecular
testing
Standard of
care
Significant
increase ▲
NNT = 4
Significant increase in provision of pathogen-directed treatment (35.3% vs. 13.4%; OR 3.53, 95% CI 2.13 to 6.02).
Secondary outcomes
Significantly shorter median time to provision of pathogen-directed treatment (34.5 hours vs. 43.8 hours; HR 0.32, 95% CI 0.2 to 0.51).
Significant increase in escalation from narrow-spectrum to broad-spectrum treatment (14.4% vs. 3.9%; OR 4.04, 95% CI 1.37 to 15.14).
Significant increase in use of single dose of antibiotics only (4.3% vs. 0%; AD 4.3%, 95% CI 0.2 to 8.4).
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients presenting to the emergency department with suspected community-acquired pneumonia, syndromic molecular testing was superior to standard of care with respect to provision of pathogen-directed treatment.
Reference
Dagfinn L Markussen, Sondre Serigstad, Christian Ritz et al. Diagnostic Stewardship in Community-Acquired Pneumonia With Syndromic Molecular Testing: A Randomized Clinical Trial. JAMA Netw Open. 2024 Mar 4;7(3):e240830.
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