Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy.
Med Mal Infect
; 46(7): 365-371, 2016 Oct.
Article
em En
| MEDLINE
| ID: mdl-27377444
ABSTRACT
BACKGROUND:
The use of rapid microbiological tests is supported by antimicrobial stewardship policies. Targeted antibiotic therapy (TAT) for community-acquired pneumonia (CAP) with positive urinary antigen test (UAT) has been associated with a favorable impact on outcome. We aimed to determine the factors associated with TAT prescription. PATIENTS ANDMETHODS:
We conducted a retrospective multicenter study including all patients presenting with CAP and positive UAT for Streptococcus pneumoniae or Legionella pneumophila from January 2010 to December 2013. Patients presenting with aspiration pneumonia, coinfection, and neutropenia were excluded. CAP severity was assessed using the Pneumonia Severity Index (PSI). TAT was defined as the administration of amoxicillin for pneumococcal infection and either macrolides or fluoroquinolones (inactive against S. pneumoniae) for Legionella infection.RESULTS:
A total of 861 patients were included, including 687 pneumococcal infections and 174 legionellosis from eight facilities and 37 medical departments. TAT was prescribed to 273 patients (32%). Four factors were found independently associated with a lower rate of TAT a PSI score≥4 (OR 0.37), Hospital A (OR 0.41), hospitalization in the intensive care unit (OR 0.44), and cardiac comorbidities (OR 0.60). Four other factors were associated with a high rate of TAT positive blood culture for S. pneumoniae (OR 2.32), Hospitals B (OR 2.34), E (OR 2.68), and H (OR 9.32).CONCLUSION:
TAT in CAP with positive UAT was related to the hospitals as well as to patient characteristics.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pneumonia Pneumocócica
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Streptococcus pneumoniae
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Doença dos Legionários
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Legionella pneumophila
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Infecções Comunitárias Adquiridas
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Gestão de Antimicrobianos
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Antibacterianos
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Antígenos de Bactérias
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article