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

Reducing antibiotics prescription is still to date, the main goal in low respiratory tract infections (LRTI).Several studies have shown conflicting results on the impact of multiplex PCR as a point of care tool. Our experience has highlighted an impact on single room assignments during the winter season but not yet on antibiotics prescriptions. This project aims to evaluate a new multimodal algorithm including multiplex PCR at the point of care to reduce antibiotics prescription and therefore has the ability to have a positive impact on antibiotics resistance phenomenon.

Inclusion Criteria:Patient 18 years or olderPresence 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 oldAlcoholic and/or tobacco intoxicationCongestive heart failureCerebrovascular disease (stroke or transient ischemic attack)Chronic kidney disease (excluding dialysis)Chronic liver diseaseUnbalanced diabetes mellitusProgressive neoplastic diseaseImmunodepression (systemic corticosteroid therapy or immunosuppressive treatment within 6 months, splenectomy, chemotherapy within 6 months, HIV at the AIDS stage, cachexia, etc.)Homozygous sickle cell diseaseBacterial pneumoniaHospitalization during the yearInstitutional lifeNon-inclusion Criteria:Patient unable to consent: coma or acute respiratory distress requiring orotracheal intubationPatient with chronic renal failure on dialysisPatient with a history of chronic obstructive pulmonary diseaseLung transplant patientPatient being treated with antibiotics at the time of the emergency room consultationPatient simultaneously participating in an interventional study protocol (assessing the duration of antibiotic therapy)Pregnant or breastfeeding womanPatient refusal to participatePatient deprived of freedom or under a legal protective measurePatient under guardianship or curatorship or with cognitive impairmentNon-affiliation to a social security regimen or CMUExclusion Criteria:• RT-PCR positive for SARS-CoV-2