Plain English Summary
Background and study aims
There is an international drive to simplify antibiotic treatments to stop side effects from antibiotics and to stop the development of superbugs.
Pneumonia is an infection of the lung affecting 5 to 11 people out of 1,000 in the population. About 9% of patients admitted to hospital with pneumonia will die. Prompt and appropriate antibiotic treatment is needed to cure the pneumonia. International guidelines suggest using a combination antibiotic treatment for 7 to 10 days for patients admitted with pneumonia. However it is not completely known what antibiotics to prescribe or for how long antibiotic treatment is needed.
By the time patients are admitted to hospital with pneumonia many of them will already have had antibiotic therapy by their GPs. This can limit the results from standard pneumonia investigations. Tests currently used in the NHS can identify the cause of pneumonia in only 39% of patients. In addition, traditional methods to investigate pneumonia in the NHS take too long to give an answer. In many cases clinicians do not have enough information to confidently shorten or reduce antibiotic treatments.
We have developed a molecular test that identifies the cause of pneumonia in 87% of patients. Our test still works even if the patient has already started antibiotic treatment. Our test is very quick and we can have a result within a few hours. We call our test a "MICAP" molecular investigation of community acquired pneumonia.
The main aim of the study is to determine if the PIB CAP test can reduce the amount of antibiotics prescribed without any undesirable clinical side effects. We will count up how much antibiotic treatment each participant had, including any additional antibiotics that might have been needed after initial treatment.
Who can participate?
Any patient at the hospital over 18 years of age who has three or more of the symptoms of lower respiratory tract infection can participate.
What does the study involve?
We will invite patients who have been admitted to hospital with lower respiratory tract infection to enrol onto our study. We will use a computer program to randomly decide which test participants will have. Half the participants will have the usual NHS tests and will receive the normal treatment for pneumonia. The other half of participants will have our molecular test and the results will customise their antibiotic treatment. We estimate that we will need to enrol 600 participants to the study in order to detect any differences between the group receiving standard NHS treatment and the group receiving customised antibiotic treatment. After 30 days each participant will have medical examinations and tests to see if it is safe to treat pneumonia with less antibiotics. We will also calculate if personalised antibiotic therapy is cost-effective for the NHS compared to the current treatment.
What are the possible benefits and risks of participating?
Benefits: guide to the best treatment for infection and limit the antibiotics to only those that are required for treatment
Risk: antibiotics that are not specific for treatment may have a benefit and these would not be provided to those taking part in the study
Where is the study run from?
Royal Infirmary of Edinburgh, UK.
When is the study starting and how long is it expected to run for?
June 2019 to June 2021
Who is funding the study?
Chief Scientist Office, Division Scotland
Who is the main contact?
Dr Kate Templeton,
Measuring the impact of improved diagnostics on antimicrobial stewardship in respiratory tract infection (MIDAS Study)
The MICAP assay to diagnose the aetiological agents in CAP and LRTI will have a result within 36 hours of hospital admission and give personalised targeted antibiotic treatment safely reducing the antibiotic burden or giving the appropriate antibiotic based on the pathogen identified.
Approved 24/08/2018 South East Scotland REC 1 (NHS Lothian, Waverley Gate, 2 - 4 Waterloo Place, Edinburgh, EH1 3EG; 0131 465 5473; Sandra.Wyllie@nhslothian.scot.nhs.uk), ref: 18/SS/0093, IRAS ID 246355
Single centre randomised controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Pneumonia, Lower respiratory tract infection
Study arm (intervention arm) – patient sputum sample will be tested by rapid pneumonia assay (MICAP) and then have treatment guided in response to results. The treatment guidance is as per standard treatment based on NHS Lothian guidelines (available at https://www.ljf.scot.nhs.uk/LothianJointFormularies/Adult/5.0/(b)/Pages/default.aspx)
The control arm – receive standard microbiology investigations and treatment in accordance with NHS Lothian guidance.
Primary outcome measure
To explore whether participants admitted with LRTI can safely receive personalised antibiotic therapy within 12 hours of consent for this test on existing sputum sample assessed by review of patient notes.
Secondary outcome measures
1. CAP resolution at days 7 and 30 (Y/N)
2. Major adverse events (Y/N) and number. Major adverse events = complicated parapneumonic effusion, empyema, lung abscess, vascular event (acute coronary syndrome or cerebrovascular accident) or antibiotic-associated C. difficile, need for inotropic support, non-invasive or invasive ventilation or another major adverse event reported by the clinician and confirmed by the adjudication committee
3. Readmissions to hospital within 30 days due to LRTI
4. Death (at 30 days and time to death)
5. Narrowing spectrum of antibiotics assessed by drug chart for antibiotics given daily from date of consent
6. Macrolide DDD assessed by drug chart for antibiotics given daily from date of consent
7. Alteration or addition of antibiotic therapy assessed by drug chart for antibiotics given daily from date of consent
8. Length of hospital stay assessed by date of admission to date of discharge. Recovered for hospital records
9. Antibiotic side effects measured from date of consent assessed by notes of side effects attributed to antibiotics in clinical notes
10. Antibiotic costs assessed by costs from Pharmacy unit of current drug costs for the course given
11. Patient symptoms assessed using a pneumonia specific questionnaire
12. Antibiotic resistance in bacteria isolated assessed by MICs of bacteria isolated, resistance markers via molecular methods for bacteria detected by PCR
13. Assess the optimum specimen(s) for assessment of LRTI for bacteria, atypical bacteria and Viruses assessed by comparison of PCR results with sputum to throat swab where they exist
14. Cost per Quality-Adjusted Life Year at 30 days
15. Cost per DDD of antibiotics at 30 days
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Aged 18 and over
3. Lower respiratory tract specimen taken for routine microbiology within 48 hours of admission and - 3 or more of following signs or symptoms of respiratory tract infection:
-new or worsening cough
-new or worsening expectoration of sputum
-new or worsening dyspnea
-pleuritic chest pain
-abnormalities on chest auscultation or percussion
Target number of participants
Participant exclusion criteria
1. Hospitalisation for more than 48 hours
2. No capacity to consent
3. Active malignancy
4. Immunodeficiency - defined as being on long term (˃28 days) oral prednisolone 10mg or more per day or other long term disease modifying drug
5. Solid organ transplant
6. All forms of pulmonary fibrosis including usual interstitial pneumonia, asbestosis, non-specific interstitial pneumonia, hypersensitivity pneumonitis, active sarcoidosis
7. Palliative treatment only
8. Mechanical ventilation
9. End of life care
10. Previously randomised into this trial
11. Participation in another CTIMP or CIMD interventional study
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Royal Infirmary of Edinburgh
51 Little France Crescent
Research and Development
Queens medical research Institute
47 Little France Crescent
0131 242 3330
Chief Scientist Office
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Summaries of results will also be made available to Investigators for dissemination within their clinics (where appropriate and according to their discretion).
The data will be disseminated at local, national level via publication in peer review journals and at international meetings in Respiratory Medicine, Internal Medicine and Infectious Diseases. Results and links to study outputs will be available on the Laboratory medicine website http://www.edinburghlabmed.co.uk/ClinicalResearch/Pages/default.aspx
IPD sharing statement:
The datasets generated during and/or analysed during the current study will be stored in a publically available repository (http://www.edinburghlabmed.co.uk/ClinicalResearch/Pages/default.aspx).
Intention to publish date
Participant level data
Stored in repository
Basic results (scientific)