Impact of Streptococcus pneumoniae Urinary Antigen Testing in Patients With Community-Acquired Pneumonia Admitted Within a Large Academic Health System

被引:4
作者
Greenfield, Adam [1 ]
Marsh, Kassandra [1 ]
Siegfried, Justin [1 ]
Zacharioudakis, Ioannis [2 ]
Ahmed, Nabeela [2 ,3 ]
Decano, Arnold [2 ,3 ]
Aguero-Rosenfeld, Maria E. [4 ]
Inglima, Kenneth [4 ]
Papadopoulos, John [1 ]
Dubrovskaya, Yanina [1 ,2 ]
机构
[1] New York Univ Langone Hlth, Dept Pharm, New York, NY USA
[2] New York Univ Langone Hlth, Dept Med, Div Infect Dis, New York, NY USA
[3] NYU, Langone Hosp Brooklyn, Dept Pharm, Brooklyn, NY USA
[4] NYU, Grossman Sch Med, Dept Pathol, 550 1St Ave, New York, NY 10016 USA
关键词
antimicrobial stewardship; community-acquired pneumonia; pneumococcal urinary antigen test; HOSPITALIZED-PATIENTS; GUIDELINE; DIAGNOSIS; OUTCOMES;
D O I
10.1093/ofid/ofab522
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Limited data support use of pneumococcal urinary antigen testing (PUAT) for patients with community-acquired pneumonia (CAP) as an antimicrobial stewardship tool. At our institution, CAP guidelines and admission order set were standardized to include universal PUAT. Methods. This was a retrospective study of adults hospitalized in 2019 who had PUAT performed. We compared incidence and timing of de-escalation in PUAT- positive vs -negative groups and described patients' outcomes. Results. We evaluated 910 patients, 121 (13.3%) of whom were PUAT positive. No difference in baseline characteristics, including severity of illness, was observed between groups. Initial de-escalation occurred in 82.9% and 81.2% of PUAT-positive and -negative patients, respectively (P = .749). Median time to de-escalation was shorter in the PUAT-positive group (1 [interquartile range {IQR}, 0-2] day vs 1 [IQR, 1-2] day, P = .01). Within 24 hours of PUAT, more patients in the PUAT-positive group had atypical coverage discontinued (61.3% vs 47.2%, P = .026) without difference in methicillin-resistant Staphylococcus aureus (MRSA) agent discontinuation (or antipseudomonal de-escalation). Among the PUAT-positive group, unadjusted analysis demonstrated shorter median length of stay in patients who were de-escalated compared to those who were not (6 [IQR, 4-10] vs 8 [IQR, 7-12] days, P = .0005), without difference in the incidence of Clostridioides difficile, in-hospital mortality, or 30-day infection-related readmission. Conclusions. We observed earlier de-escalation in the PUAT-positive group. This seems to be due to discontinuation of atypical rather than anti-MRSA or antipseudomonal coverage. Further antimicrobial stewardship interventions are warranted.
引用
收藏
页数:8
相关论文
共 18 条
[1]   A positive pneumococcal urinary antigen test promotes narrow spectrum antibiotic use in patients with non-invasive pneumococcal pneumonia [J].
Banks, Richard ;
Zappernick, Taissa ;
Wilson, Brigid ;
Perez, Federico ;
Jump, Robin L. P. .
DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE, 2020, 96 (02)
[2]   Community-acquired Pneumonia Secondary to Legionella pneumophila and Streptococcus [J].
Beg, Moeezullah ;
Arif, Hamza ;
Walsh, Thomas .
CUREUS JOURNAL OF MEDICAL SCIENCE, 2019, 11 (02)
[3]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[4]   Adherence to guidelines for hospitalized community-acquired pneumonia over time and its impact on health outcomes and mortality [J].
Costantini, Elisa ;
Allara, Elias ;
Patrucco, Filippo ;
Faggiano, Fabrizio ;
Hamid, Fozia ;
Balbo, Piero Emilio .
INTERNAL AND EMERGENCY MEDICINE, 2016, 11 (07) :929-940
[5]   Cost effectiveness of pneumococcal urinary antigen in Emergency Department: a pragmatic real-life study [J].
Dinh, Aurelien ;
Duran, Clara ;
Davido, Benjamin ;
Lagrange, Aurore ;
Sivadon-Tardy, Valerie ;
Bouchand, Frederique ;
Beauchet, Alain ;
Gaillard, Jean-Louis ;
Beaune, Sebastien ;
Salomon, Jerome ;
Grenet, Julie .
INTERNAL AND EMERGENCY MEDICINE, 2018, 13 (01) :69-73
[6]  
Falguera M, 2010, THORAX, V65, P101, DOI 10.1136/thx.2009.118588
[7]   A prediction rule to identify low-risk patients with community-acquired pneumonia [J].
Fine, MJ ;
Auble, TE ;
Yealy, DM ;
Hanusa, BH ;
Weissfeld, LA ;
Singer, DE ;
Coley, CM ;
Marrie, TJ ;
Kapoor, WN .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (04) :243-250
[8]   Community-Acquired Pneumonia Requiring Hospitalization among US Adults [J].
Jain, S. ;
Self, W. H. ;
Wunderink, R. G. ;
Fakhran, S. ;
Balk, R. ;
Bramley, A. M. ;
Reed, C. ;
Grijalva, C. G. ;
Anderson, E. J. ;
Courtney, D. M. ;
Chappell, J. D. ;
Qi, C. ;
Hart, E. M. ;
Carroll, F. ;
Trabue, C. ;
Donnelly, H. K. ;
Williams, D. J. ;
Zhu, Y. ;
Arnold, S. R. ;
Ampofo, K. ;
Waterer, G. W. ;
Levine, M. ;
Lindstrom, S. ;
Winchell, J. M. ;
Katz, J. M. ;
Erdman, D. ;
Schneider, E. ;
Hicks, L. A. ;
McCullers, J. A. ;
Pavia, A. T. ;
Edwards, K. M. ;
Finelli, L. .
NEW ENGLAND JOURNAL OF MEDICINE, 2015, 373 (05) :415-427
[9]   A Reappraisal of Streptococcal Urinary Antigen Testing for Antibiotic Stewardship [J].
Kadri, Sameer S. .
CLINICAL INFECTIOUS DISEASES, 2020, 71 (06) :1435-1437
[10]   Diagnosis and Treatment of Adults with Community-acquired Pneumonia An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America [J].
Metlay, Joshua P. ;
Waterer, Grant W. ;
Long, Ann C. ;
Anzueto, Antonio ;
Brozek, Jan ;
Crothers, Kristina ;
Cooley, Laura A. ;
Dean, Nathan C. ;
Fine, Michael J. ;
Flanders, Scott A. ;
Griffin, Marie R. ;
Metersky, Mark L. ;
Musher, Daniel M. ;
Restrepo, Marcos, I ;
Whitney, Cynthia G. .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2019, 200 (07) :E45-E67