SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Background: International guidelines recommend antibiotics for acute exacerbations of COPD (AECOPD), but evidence of benefit outside of a critical care setting, is unclear. Given increasing antimicrobial resistance, it is imperative to identify if some AECOPD can be treated without antibiotics. A systematic review of procalcitonin demonstrated a reduction in antibiotic prescribing in AECOPD without worsening outcomes in the non-critical care setting. C reactive protein (CRP) is another candidate biomarker that could perform similarly. Objectives: To determine in adults presenting with AECOPD, whether CRP-guided antibiotic prescribing versus based on symptoms, can reduce antibiotic dispensing without increasing treatment failure. METHODS: Data source: The databases MEDLINE (Ovid), EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for all dates up to October 14th, 2019 for related studies. Methods: The study was conducted in accordance with PRISMA guidelines. Inclusion criteria included randomized controlled studies assessing adults (>18 years of age) presenting with an AECOPD assessing CRP-guided antibiotic prescribing versus standard of care prescribing. A meta-analysis was conducted using a random effects model. RESULTS: A total of 1634 records were identified, 17 full texts were reviewed, and finally only 2 RCTs met inclusion criteria, one in the outpatient setting, and one in hospitalized patients with AECOPD. CRP-guidance versus standard of care reduced initial antibiotic Rx within 24h of randomization RR of 0.68 (95% CI 0.60 – 0.78), and there was no difference in treatment failure RR 1.03 (95%CI 0.8, 1.37), or symptom resolution. Only one trial reported on mortality (no difference), length of stay (longer in the CRP group by 1 day), and time to next exacerbation (longer in the CRP group). Adverse events appeared similar in both groups. CONCLUSIONS: CRP-guided antibiotics reduced antibiotic prescribing with no difference in treatment failure and symptom resolution but the quality of evidence is low for clinical outcomes. CLINICAL IMPLICATIONS: Low quality evidence from Europe supports that CRP-guided antibiotics in AECOPD of patients with FEV1> 30% predicted, can reduce antibiotic prescribing without increasing adverse events in non-critically ill outpatient and inpatients. It remains unclear how many CRP-cut offs are ideal, nor does it answer which biomarker, CRP or procalcitonin, is best. Until we have more data, any implementation of this strategy should be made in a low-risk population, or in a research setting. Additional trials with a focus on reducing bias are needed. A network meta-analysis of the procalcitonin and CRP trials might help elucidate which bio-marker is superior in lieu of, or prior to, moving forward with an expensive RCT. DISCLOSURES: No relevant relationships by Samar Ahmed, source=Web Response No relevant relationships by Vanessa Luks, source=Web Response