Infection point of care tests bridge the experience gap of antibiotic STOP decisions: clinicians versus students
File(s)
Published version
Author(s)
Type
Journal Article
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.
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.
Date Issued
2026-04-01
Date Acceptance
2025-12-15
Citation
Journal of Antimicrobial Chemotherapy, 2026, 81 (4)
ISSN
0305-7453
Publisher
Oxford University Press (OUP)
Journal / Book Title
Journal of Antimicrobial Chemotherapy
Volume
81
Issue
4
Copyright Statement
© The Author(s) 2026. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41793742
PII: 8510606
Subjects
Humans
Anti-Bacterial Agents
Antimicrobial Stewardship
Point-of-Care Testing
Students, Medical
Male
Female
Adult
Clinical Decision-Making
Decision Making
Practice Patterns, Physicians'
Publication Status
Published
Coverage Spatial
England
Article Number
dkaf486
Date Publish Online
2026-03-07