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The extent of microbiological testing is associated with alteration of antibiotic therapy in adults with community-acquired pneumonia

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Abstract

The aim of this study was to explore the relationship between the extent of microbiological testing and the frequency of antibiotic alteration in adults hospitalised with community-acquired pneumonia (CAP). We retrospectively studied 283 immunocompetent patients hospitalised with CAP. Information on microbiological testing and prescribed antibiotics was obtained. Patients were grouped according to the number of different microbiological tests performed within the first 2 days of admission (0–5 tests). Alteration rates were compared between these groups. Antimicrobial alteration was defined as a switch at day 3 of hospital stay to (1) a narrower spectrum antibiotics, or (2) a different class of antibiotics, or (3) a switch from dual therapy to monotherapy (4) or discontinuation of antibiotic treatment because the indication for antibiotic treatment did no longer exist. For each additional test performed, a stepwise increase in percentage of patients with altered antibiotic regimen ranging from 0 to 59% (p = 0.001) was found. Multivariate logistic regression analyses showed that performing PCR assay for atypical pathogens was most strongly associated with any alteration of antibiotic treatment (OR 2.6 (95% CI 1.4–4.9)) and with changes in atypical coverage specifically (OR 3.1 (95% CI 1.6–6.0). The extent of microbiological testing was positively associated with antibiotic alteration in adults hospitalised with CAP. Antibiotic treatment was most likely to be altered in patients in whom PCR assay for atypical pathogens was performed.

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References

  1. van den BCMA, Geerlings SE, Natsch S, Prins JM, Hulscher MEJL (2015) Quality indicators to measure appropriate antibiotic use in hospitalized adults. Clin Infect Dis 60:281–291. https://doi.org/10.1093/cid/ciu747

    Article  CAS  Google Scholar 

  2. Pakhale S, Mulpuru S, Verheij TJM, Kochen MM, Rohde GGU, Bjerre LM (2014) Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst Rev doi: https://doi.org/10.1002/14651858.CD002109.pub4

  3. Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K (2008) Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J 32:139 139–139 146. https://doi.org/10.1183/09031936.00092507

    Article  PubMed  Google Scholar 

  4. Garcia-Vidal C, Fernández-Sabé N, Carratalà J et al (2008) Early mortality in patients with community-acquired pneumonia: causes and risk factors. Eur Respir J 32:733 733–733 739. https://doi.org/10.1183/09031936.00128107

    Article  PubMed  Google Scholar 

  5. Schuts EC, Hulscher MEJL, Mouton JW et al (2016) Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis 16:847–856. https://doi.org/10.1016/S1473-3099(16)00065-7

    Article  PubMed  Google Scholar 

  6. Carratalà J, Garcia-Vidal C, Ortega L, Fernández-Sabé N, Clemente M, Albero G et al (2012) Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial. Arch Intern Med 172:922–928. https://doi.org/10.1001/archinternmed.2012.1690

    Article  PubMed  Google Scholar 

  7. Paterson DL (2004) “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 38:S341–S345

    Article  CAS  PubMed  Google Scholar 

  8. Musher DM, Thorner AR (2014) Community-acquired pneumonia. N Engl J Med 371:1619–1628. https://doi.org/10.1056/NEJMra1312885

    Article  CAS  PubMed  Google Scholar 

  9. Wiersinga WJ, Bonten MJ, Boersma WG, et al (2016) Management of community-acquired pneumonia in adults: 2016 guideline update from the Dutch Working Party on Antibiotic Policy (SWAB) and Dutch Association of Chest Physicians (NVALT). SWAB/NVALT; 2016. http://www.swab.nl/swab/cms3.nsf/uploads/6A6E127F9A2C1168C125816F004A013A/$FILE/CAP_SWAB_2017-DEF_R5.pdf. Accessed 4 Jan 2019

  10. File TM Jr (2011) New diagnostic tests for pneumonia: what is their role in clinical practice? Clin Chest Med 32:417–430. https://doi.org/10.1016/j.ccm.2011.05.011

    Article  PubMed  Google Scholar 

  11. van der EMM, Vlaspolder F, de GCS, Groot T, Jansen HM, Boersma WG (2005) Value of intensive diagnostic microbiological investigation in low- and high-risk patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 24:241–249. https://doi.org/10.1007/s10096-005-1316-8

    Article  Google Scholar 

  12. Johansson N, Kalin M, Tiveljung-Lindell A, Giske CG, Hedlund J (2010) Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis 50:202–209. https://doi.org/10.1086/648678

    Article  PubMed  Google Scholar 

  13. Andreo F, Domínguez J, Ruiz J et al (2006) Impact of rapid urine antigen tests to determine the etiology of community-acquired pneumonia in adults. Respir Med 100:884–891. https://doi.org/10.1016/j.rmed.2005.08.020

    Article  PubMed  Google Scholar 

  14. Lim W, van der EMM, Laing R et al (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377–382. https://doi.org/10.1136/thorax.58.5.377

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. van de GEMW, Plouvier BC, Fleuren HWHA et al (2019) Pharmacotherapy within a learning healthcare system: rationale for the Dutch Santeon Farmadatabase. Eur J Hosp Pharm 26:46–50. https://doi.org/10.1136/ejhpharm-2017-001329

    Article  Google Scholar 

  16. Wiersinga W, Bonten M, Boersma W et al (2012) SWAB/NVALT (Dutch Working Party on Antibiotic Policy and Dutch Association of Chest Physicians) guidelines on the management of community-acquired pneumonia in adults. Neth J Med 70(2):90–101

    CAS  PubMed  Google Scholar 

  17. Oosterheert JJ, van LAM, Schuurman R et al (2005) Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis 41:1438–1444 https://doi.org/10.1086/497134

    Article  PubMed  Google Scholar 

  18. Vestjens SMT, Wittermans E, Spoorenberg SMC et al (2018) Inter-hospital variation in the utilization of diagnostics and their proportionality in the management of adult community-acquired pneumonia. Pneumonia 10:15. https://doi.org/10.1186/s41479-018-0059-0

    Article  PubMed  PubMed Central  Google Scholar 

  19. Postma DF, van WCH, van ELJR et al (2015) Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med 372:1312–1323. https://doi.org/10.1056/NEJMoa1406330

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by a grant from the St. Antonius Research Fund via an earmarked donation from Verwelius Construction Corporation for research on CAP.

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Author notes

  1. Esther Wittermans and Stefan M. T. Vestjens contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, St. Antonius Hospital, Koekoekslaan 1, P.O. Box 2500, 3430 EM, Nieuwegein, the Netherlands

    Esther Wittermans & Willem Jan W. Bos

  2. Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands

    Stefan M. T. Vestjens & Bart J. M. Vlaminckx

  3. Department of Internal Medicine – Division Nephrology, Leiden University Medical Centre, Leiden, the Netherlands

    Willem Jan W. Bos

  4. Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands

    Jan C. Grutters

  5. Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, the Netherlands

    Jan C. Grutters

  6. Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands

    Ewoudt M. W. van de Garde

  7. Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands

    Ewoudt M. W. van de Garde

Authors
  1. Esther Wittermans
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  2. Stefan M. T. Vestjens
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  3. Willem Jan W. Bos
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  4. Jan C. Grutters
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Corresponding author

Correspondence to Esther Wittermans.

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The study was approved by the Medical Ethics Committee of the St. Antonius Hospital (Nieuwegein).

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The authors declare that they have no conflict of interest.

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Wittermans, E., Vestjens, S.M.T., Bos, W.J.W. et al. The extent of microbiological testing is associated with alteration of antibiotic therapy in adults with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 38, 1359–1366 (2019). https://doi.org/10.1007/s10096-019-03561-8

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  • DOI: https://doi.org/10.1007/s10096-019-03561-8

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