NCT03360851: CAP-NEXT

DiagNostic Study of Low-dose CT and multipleX PCR on Antibiotic Treatment and Outcome of Community-Acquired Pneumonia

Terminated NA Last updated 21 May 2021

What this trial tests

NA trial testing low-dose CT in Community-acquired Pneumonia in 3,555 participants. Terminated before completion.

Timeline

27 November 2017

Primary endpoint
24 June 2020

1 March 2021

Quick facts

Lead sponsor	MJM Bonten
Phase	NA
Status	Terminated
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	none
Primary purpose	diagnostic
Enrollment	3,555
Start date	27 November 2017
Primary completion	24 June 2020
Estimated completion	1 March 2021
Sites	7 locations across Netherlands

Drugs / interventions tested

• low-dose CT
• PoC-PCR

Conditions studied

• Community-acquired Pneumonia — all drugs for Community-acquired Pneumonia →

Sponsor

MJM Bonten — full company profile →

Who can join

18 and older, any sex, with Community-acquired Pneumonia. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Rationale:

Uncertainty in the clinical and etiological diagnosis of community-acquired pneumonia (CAP) often leads to incorrect treatment and unnecessary use of broad-spectrum antibiotics. Establishing the clinical diagnosis of CAP is hampered by the suboptimal sensitivity of chest radiograph to detect pulmonary infiltrates (\~70%). Establishing the etiological diagnosis is also hampered, mainly because of the inevitable diagnostic delays and low sensitivity of routine microbiological tests. There are currently no recommendations for low-dose chest computed tomography (low-dose CT) or viral and bacterial point-of-care multiplex polymerase chain reaction (PoC-PCR) in the diagnostic work-up of CAP patients, because the data supporting such an approach are lacking.

Objective: The aim of this study is to determine the added value of low-dose CT and PoC-PCR in the diagnostic workup of patients with CAP hospitalised to non-intensive care unit (ICU) wards in minimizing selective antibiotic pressure while maintaining patient safety.

Study design: Cluster-randomised controlled trial with historical control period.

Study population: Adult patients (\>=18 years old) with a clinical diagnosis of CAP requiring hospitalisation to a non-ICU ward.

Intervention: Intervention arm 1: availability of PoC-PCR during the ER visit; intervention arm 2: performing low-dose CT from the ER or at least within 24 hours; control arm: standard care.

Main study parameters/endpoints: The primary effectiveness outcome is days of therapy of broad-spectrum antibiotics. The primary safety outcome, on which the sample size is calculated, is 90-day all-cause mortality.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: There are no risks associated with performing the PoC-PCR and the radiation of the low-dose CT is of negligible risk. Nasopharyngeal swab collection causes a temporary unpleasant sensation. The low-dose CT can reveal unexpected findings which may require additional diagnostic procedures, for which the treating physician will use state-of-the-art guidelines. Treatment recommendations to de-escalate or stop antibiotic treatment may be beneficial for the individual patient by minimising exposure to antibiotics and improve targeted use of antibiotics. Final decisions are always made by the treating physician taking into account all clinical information.

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

1. Process evaluation of an effective Antimicrobial Stewardship intervention in hospitalized patients with community-acquired pneumonia.
   van Heijl I, van den Eijnde SEJD, Schweitzer VA, van Werkhoven CH, et al · · 2026 · PMID 42038606 · DOI 10.1017/ash.2026.10340