{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:35:53Z","timestamp":1770816953146,"version":"3.50.1"},"reference-count":39,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Institute for Health","award":["NIHR300669"],"award-info":[{"award-number":["NIHR300669"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,6,11]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Non-ventilator-associated hospital-acquired pneumonia (nv-HAP) is the most common healthcare-associated infection (HCAI), is associated with high mortality and morbidity and places a major burden on healthcare systems. Diagnosis currently relies on chest x-rays to confirm pneumonia and sputum cultures to determine the microbiological cause. This approach leads to over-diagnosis of pneumonia, rarely identifies a causative pathogen and perpetuates unnecessary and imprecise antibiotic use. The HAP-FAST study aims to evaluate the feasibility of a randomised trial to evaluate the clinical impact of low-dose, non-contrast-enhanced thoracic CT scans and rapid molecular sputum analysis using the BIOFIRE\u00ae FILMARRAY\u00ae pneumonia\n                      <jats:italic>plus<\/jats:italic>\n                      panel (FAPP) for patients suspected with nv-HAP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The HAP-FAST feasibility study consists of a pilot randomised trial, a qualitative study, a costing analysis and exploratory analyses of clinical samples to investigate the immune-pathophysiology of HAP. Participants are identified and recruited from four acute hospitals in the Northwest of the UK. Using a Research Without Prior Consent model, the pilot trial will recruit 220 adult participants, with or without mental capacity, and with suspected HAP. HAP-FAST is a non-blinded, sequential, multiple assignment, randomised trial with two possible stages of randomisation: first, chest x-ray (CXR) or CT; second, if treated as nv-HAP, FAPP or standard microbiological processing alone (no FAPP). Pathogen-specific antibiotic guidance will be provided for FAPP results. Randomisation uses a web-based platform and followed up for 90 days. The feasibility of a future trial will be determined by assessing trial processes, outcome measures and patient and staff experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has undergone combined review by the UK NHS Research Ethics Committee and Health Research Authority. Results will be disseminated via peer-reviewed journals, via the funders\u2019 website and through a range of media to engage the public.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05483309\">NCT05483309<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-088490","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T12:32:05Z","timestamp":1720096325000},"page":"e088490","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["HAP-FAST: a feasibility study incorporating qualitative, mechanistic and costing sub-studies alongside a randomised pilot trial comparing chest x-ray to low-dose CT scan and empirical antibiotics to antibiotics guided by the BIOFIRE\u00ae FILM ARRAY\u00ae pneumonia\n                    <i>plus<\/i>\n                    panel in adults with suspected non-ventilator-associated hospital-acquired pneumonia"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct05483309","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7506-9554","authenticated-orcid":false,"given":"Natalia","family":"Shafiqa","sequence":"first","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK"},{"name":"Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Aston","sequence":"additional","affiliation":[{"name":"Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"},{"name":"Department of Antimicrobial Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4195-6821","authenticated-orcid":false,"given":"Alex","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Antimicrobial Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK"},{"name":"Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lance","family":"Turtle","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK"},{"name":"Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"},{"name":"NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Abrams","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bridget","family":"Young","sequence":"additional","affiliation":[{"name":"Institute of Population Health, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances","family":"Sherratt","sequence":"additional","affiliation":[{"name":"Institute of Population Health, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anica","family":"Alvarez Nishio","sequence":"additional","affiliation":[{"name":"Patient and Public 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