Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia–A register-based cohort study - 03/07/22
, Anders Magnuson b, Carl Spindler c, d, Jonas Hedlund c, d, Kristoffer Strålin d, e, Pontus Nauclér c, dHighlights |
• | Routinely performing pneumococcal urinary antigen tests needs to be evalUATed. |
• | Performing urinary antigen test has little effect on antibiotic therapy in pneumonia. |
• | Mild pneumonia with a positive test is less frequently treated with broad-spectrum antibiotics. |
• | Severe pneumonia is treated with broad-spectrum antibiotics regardless of test result. |
Abstract |
Objectives |
To evaluate the effect of pneumococcal urinary antigen test (UAT) usage on broad-spectrum antibiotic treatment in community-acquired pneumonia (CAP).
Methods |
Patients admitted to 32 Swedish hospitals between 2011 and 2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM).
Results |
UAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94–1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06–2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25–0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16–0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69–3.98) and 3–4 (OR 3.69, 95% CI 1.55–8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3–4 patients (OR 3.49, 95% CI 1.02–12.0).
Conclusions |
Performing UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.
Le texte complet de cet article est disponible en PDF.Keywords : Community-acquired pneumonia, Urinary antigen test, Streptococcus pneumoniae, Broad-spectrum antibiotics, Pneumococcus, Antibiotic stewardship
Plan
Vol 85 - N° 2
P. 167-173 - août 2022 Retour au numéro
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