Infection point of care tests bridge the experience gap of antibiotic STOP decisions: clinicians versus students

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Abstract
Background: Point of care tests (POCTs) offer accurate rapid diagnostics for infection, but not reduced antibiotic overuse in antibiotic stewardship (ABS) studies. Prescribing behaviour shaped by clinical experience may influence antibiotic decisions more than test performance. Understanding prescribing behavioural differences may inform ABS education. Objectives: To find out whether antibiotic decision making differ among medical students and intensive care clinicians when offered POCT use. Methods: An observational study depicted four simulated clinical vignettes of hospital acquired pneumonia. Clinicians and students decided to STOP or continue antibiotics, before and after a PCR-POCT result (negative for infection). Four clinico-biological (WBC/CRP) trajectories were tested: ‘clinical-biological improvement’, ‘clinical improvement/biological worsening’, ‘clinical worsening/biological improvement’ and ‘clinical-biological worsening’. STOP decisions, POCT requests and willingness to stop antibiotics were compared between groups using Chi-squared analysis, Wilcoxon-rank and logistic regression analyses. Results: Eighty-eight students and 70 clinicians participated. Pre-POCT, students stopped antibiotics less than clinicians (42% versus 53%, P = 0.007); most markedly in ‘clinical improvement/biological worsening’ (36% versus 73%, P < 0.001). Both groups requested POCT equally (65% versus 67%, P = 0.65). Negative POCT results raised student STOP rates to those of clinicians (70% versus 67%, P = 0.466); the greatest rise being in ‘clinical improvement/biological worsening’ (P = 0.006). Conclusions: Infection-detecting POCTs (negative) improved students’ antibiotic stop rates to the level of clinicians, particularly in cases of clinico-biological ambiguity. A requested and negative POCT result can reduce (over)cautious prescribing, especially with ambiguous trajectories. Such simulated clinical infection vignettes offer a learning tool to improve antimicrobial judgement, and confidence in POCT driven decision making.

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