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PneumoniaCAPNORNCT04660084

Impact of Molecular Testing on Improved Diagnosis, Treatment and Management of CAP

A study testing Ultra-rapid molecular point-of-care testing in people with Pneumonia, run by Haukeland University Hospital at 1 site in Norway.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Investigators will recruit patients suspected of community-acquired pneumonia at Haukeland University Hospital, Bergen, into a pragmatic randomized controlled trial to assess if provision of ultra-rapid, high-quality accurate molecular diagnostics with direct feedback to the clinician can facilitate pathogen-directed… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Pneumonia
What is being tested?
Ultra-rapid molecular point-of-care testing
Could I receive a placebo?
No, everyone receives an active treatment
How many people
374 participants
Where
1 siteNorway
Study dates
25 Sep 2020to 21 Jun 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults (aged ≥18 years),
  • Clinical diagnosis of CAP (presence of at least two clinical criteria [new/worsening cough, new/worsening expectoration of sputum, haemoptysis, new/worsening dyspnoea, pleuritic chest pain, fever, or abnormalities on chest auscultation or percussion] or one clinical criterion and radiological evidence of CAP)
  • Requiring hospitalisation to a non-ICU ward
  • Capacity to give informed written consent or consent provided by the patient's legally authorized representative.

Who cannot join

  • Pulmonary embolism
  • Lung tumor
  • Cystic fibrosis
  • Palliative approach
  • Patients who decline to provide respiratory tract specimens
  • Severe immunodeficiency
  • Hospitalization for two or more days in the last 14 days

Trial locations and contacts

1 site in 1 country.

Norway1 site
  • Haukeland University Hospital

    Bergen, 5098

Other trials in Norway

About this study

Official title: Impact of Molecular Testing on Improved Diagnosis, Treatment and Management of CAP in Norway: a Pragmatic Randomised Controlled Trial

Investigators will recruit patients suspected of community-acquired pneumonia at Haukeland University Hospital, Bergen, into a pragmatic randomized controlled trial to assess if provision of ultra-rapid, high-quality accurate molecular diagnostics with direct feedback to the clinician can facilitate pathogen-directed usage of antibiotics, shorten antibiotic exposure and admission time and is safe. Additionally, transcriptional and immune marker profiling of patients will guide appropriate management through a targeted focus on the individual patient's physical capacity, nutritional status and co- morbidities. The pragmatic design of this trial together with broad inclusion criteria and a straightforward intervention would make our results generalisable to other similar centres.

Read the detailed description

The study is a pragmatic, single-blind, single-centre randomised controlled trial (RCT) where community-acquired pneumonia (CAP) patients will receive standard of care microbiological testing or standard of care microbiological testing and comprehensive ultra-rapid molecular testing (UR-MT).

Investigators will over a 3-year period (2020-2022), consecutively enroll cases of CAP admitted (~900/year) to Haukeland University Hospital (HUS, Bergen). The study will consist of representative patients admitted with CAP and thus, will potentially be generalisable to hospitalised patients with CAP in Norway. As COVID-19 cannot be distinguished clinically from other pneumonias, the study will therefore include patients with suspected CAP, including with COVID-19. Approximately 1500 CAP patients will be screened to achieve a total of 1060 (allowing for a 10% dropout rate) enrolled patients that are randomly assigned to receive standard of care microbiological testing or standard of care testing microbiological and the comprehensive ultra-rapid molecular test (UR-MT).

Inclusion criteria for the study are: adults (aged ≥18 years), with a clinical diagnosis of CAP (presence of at least two clinical criteria [new/worsening cough, new/worsening expectoration of sputum, haemoptysis, new/worsening dyspnoea, pleuritic chest pain, fever, or abnormalities on chest auscultation or percussion] or one clinical criterion and radiological evidence of CAP), requiring hospitalisation to a non-ICU ward, and with a capacity to give informed written consent or consent provided by the patient's legally authorized representative.

Exclusion criteria include: lung tumour, cystic fibrosis, a palliative approach, patients who decline to provide respiratory tract specimens, severe immunodeficiency, and hospitalization for two or more days in the last 14 days.

Based on clinical evaluation and data of admission, patients will be triaged for severity according to current risk assessment guidelines, as well as the CRB-65 score for the assessment of severity of pneumonia. Randomization of CAP patients to the two treatment arms (1:1) will be performed in blocks of size 4, 6, or, 8, occurring in random order, to ensure approximately equal allocation over the year.

The prescribed empirical therapy for each patient will be compared with what antimicrobial(s) would have been appropriate for pathogen-directed therapy, based on the UR-MT result. Appropriate pathogen-directed therapy will be determined using national guidelines recommended by the Norwegian directorate of health

Conditions
Pneumonia
Being tested
Ultra-rapid molecular point-of-care testing
Keywords
Microbiology, Bacteria and viruses, Rapid diagnosis, Antibiotic resistance, Diagnostic stewardship
Medical subject headings
Pneumonia, Virus Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ultra-rapid molecular point-of-care testingDiagnostic test

    Also called BioFire® FilmArray® Pneumonia plus platform (Biomérieux)

    Ultra-rapid molecular testing (UR-MT) comprises automated detection using the new BioFire® FilmArray® Pneumonia plus platform (Biomérieux). The total turn-around time is <2 hrs.

    The UR-MT is combined with standard of care, comprising:

    Microbiological processing per current standard of care entails culture of respiratory tract samples according to national protocols to detect respiratory bacteria, identified using biochemical methods and/or matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF MS). Respiratory viruses are identified using real-time PCR (for metapneumovirus, rhinovirus, influenza A, influenza B, parainfluenza 1-3, RSV and SARS-CoV-2). The total turn-around time is up to 48 hrs.

Study groups in NCT04660084
Study groupRoleWhat they receive
Ultra-rapid molecular point-of-care testingOtherExtended and more rapid diagnostics on microbiological specimens and an active feedback to treating staff with results.
Receives: Diagnostic Test: Ultra-rapid molecular point-of-care testing
Standard of careNo interventionStandard collection of microbiological specimens and standard reply to treating staff.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The provision of pathogen-directed treatment based on a microbiological test result deemed as clinically relevant within 48 hours of receipt of respiratory samples.

    Binary outcome: yes: it was provided/no: it was not provided

    Measured: "Up to 72 hours"

  2. Time in hours from receipt of respiratory specimens to receiving pathogen-directed treatment

    Quantitative outcome (measured in hours): time from receipt of respiratory specimens to provision of pathogen-directed treatment based on a microbiological test result deemed as clinically relevant or an elapse of 48 hours, whichever event came first.

    Measured: "Up to 72 hours"

Secondary outcomes (12)
  1. Duration of antibiotic use in days

    Duration of antibiotic use in days

    Measured: "Up to 4 weeks"

  2. Proportion of patients receiving narrow-spectrum antibiotics within 48 hours from study inclusion

    Proportion of patients receiving narrow-spectrum antibiotics within 48 hours from study inclusion

    Measured: "Up to 4 weeks"

  3. Proportion of patients receiving a single dose of antibiotics

    Proportion of patients receiving a single dose of antibiotics

    Measured: "Up to 1 week"

  4. Proportion of patients receiving ≤48 h of antibiotics

    Proportion of patients receiving ≤48 h of antibiotics

    Measured: "Up to 1 week"

  5. Proportion of patients receiving intravenous antibiotics

    Proportion of patients receiving intravenous antibiotics

    Measured: "Up to 1 week"

  6. Duration of intravenous antibiotics in days

    Duration of intravenous antibiotics in days

    Measured: "Up to 4 weeks"

  7. Proportion of cases where the UR-MT results were used to guide treatment

    Proportion of cases where the UR-MT results were used to guide treatment

    Measured: "Up to 1 week"

  8. Time in days to isolation or de-isolation

    Time in days to isolation or de-isolation

    Measured: "Up to 2 weeks"

  9. Duration of "door-to-needle time" in hours

    Duration of "door-to-needle time" in hours

    Measured: "Up to 1 week"

  10. Length of hospital stay in days

    Length of hospital stay in days

    Measured: "Up to 3 months"

  11. Proportion of 30-day readmission

    Proportion of 30-day readmission

    Measured: "Up to 30 days from discharge"

  12. Proportion of 30- and 90-day and 1- and 5 year mortality

    Proportion of 30- and 90-day and 1- and 5 year mortality

    Measured: "Up to 1 month, 3 months, 1 and 5 years, from admission"

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Dec 2020
  2. Study start25 Sep 2020
  3. Primary completion21 Jun 2022
  4. Study completion21 Jun 2022

Why it stopped: The trial was stopped earlier than planned after an ad hoc interim analysis

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Model description
A pragmatic, parallel-arm, single-blinded, single-centre, randomised controlled superiority trial
Masking
Single blind
Who is masked
Participant
Enrolment
374 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04660084
Sponsor's protocol ID
HaukelandUH_31935
Acronym
CAPNOR
Status last verified
Mar 2022
First submitted
12 Nov 2020
Last updated
26 Oct 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Saghaug CS, Markussen DL, Knoop ST, Holvik BC, Serigstad S, Ulvestad E, Ritz C, Jenum S, Grewal HMS. Diagnostic accuracy of a host response test in suspected community-Acquired pneumonia during the COVID-19 era. Int J Infect Dis. 2025 Nov;160:108045. doi: 10.1016/j.ijid.2025.108045. Epub 2025 Sep 2.

    PubMed 40907740
  • Markussen DL, Wathne JS, Ritz C, van Werkhoven CH, Serigstad S, Bjorneklett RO, Ulvestad E, Knoop ST, Jenum S, Grewal HMS. Determinants of non-adherence to antibiotic treatment guidelines in hospitalized adults with suspected community-acquired pneumonia: a prospective study. Antimicrob Resist Infect Control. 2024 Nov 23;13(1):140. doi: 10.1186/s13756-024-01494-2.

    PubMed 39580437
  • Markussen DL, Serigstad S, Ritz C, Knoop ST, Ebbesen MH, Faurholt-Jepsen D, Heggelund L, van Werkhoven CH, Clark TW, Bjorneklett RO, Kommedal O, Ulvestad E, Grewal HMS. Diagnostic Stewardship in Community-Acquired Pneumonia With Syndromic Molecular Testing: A Randomized Clinical Trial. JAMA Netw Open. 2024 Mar 4;7(3):e240830. doi: 10.1001/jamanetworkopen.2024.0830.

    PubMed 38446481
  • Serigstad S, Knoop ST, Markussen DL, Ulvestad E, Bjorneklett RO, Ebbesen MH, Kommedal O, Grewal HMS. Diagnostic utility of oropharyngeal swabs as an alternative to lower respiratory tract samples for PCR-based syndromic testing in patients with community-acquired pneumonia. J Clin Microbiol. 2023 Sep 21;61(9):e0050523. doi: 10.1128/jcm.00505-23. Epub 2023 Aug 16.

    PubMed 37585220
  • Serigstad S, Ritz C, Faurholt-Jepsen D, Markussen D, Ebbesen MH, Kommedal O, Bjorneklett RO, Heggelund L, Clark TW, van Werkhoven CH, Knoop ST, Ulvestad E, Grewal HMS; CAPNOR study group. Impact of rapid molecular testing on diagnosis, treatment and management of community-acquired pneumonia in Norway: a pragmatic randomised controlled trial (CAPNOR). Trials. 2022 Aug 1;23(1):622. doi: 10.1186/s13063-022-06467-7.

    PubMed 35915452

Questions about this trial

What is this clinical trial studying?

A study testing Ultra-rapid molecular point-of-care testing in people with Pneumonia, run by Haukeland University Hospital at 1 site in Norway.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 26 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: The trial was stopped earlier than planned after an ad hoc interim analysis). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The provision of pathogen-directed treatment based on a microbiological test result deemed as clinically relevant within 48 hours of receipt of respiratory samples. (time frame: "Up to 72 hours"). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04660084, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Oct 2023.

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