Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis

被引：10

作者：

Abelenda-Alonso, Gabriela ^{[1
,2
]}

Rombauts, Alexander ^{[1
,2
]}

Gudiol, Carlota ^{[1
,2
,3
,4
]}

Garcia-Lerma, Esther ^{[5
]}

Pallares, Natalia ^{[5
]}

Ardanuy, Carmen ^{[3
,6
,7
]}

Calatayud, Laura ^{[6
,7
]}

Niubo, Jordi ^{[4
,6
]}

Tebe, Cristian ^{[5
]}

Carratala, Jordi ^{[1
,2
,3
,4
]}

机构：

[1] Bellvitge Univ Hosp, Dept Infect Dis, Barcelona, Spain

[2] Bellvitge Biomed Res Inst IDIBELL, Barcelona, Spain

[3] Univ Barcelona, Barcelona, Spain

[4] Inst Salud Carlos III, Ctr Biomed Res Infect Dis Network CIBERINFEC, Madrid, Spain

[5] IDIBELL, Biostat Unit, Barcelona, Spain

[6] Bellvitge Univ Hosp, Dept Clin Microbiol, Barcelona, Spain

[7] Inst Salud Carlos III, Ctr Biomed Res Resp Dis Network CIBERES, Madrid, Spain

来源：

CLINICAL MICROBIOLOGY AND INFECTION | 2022年 / 28卷 / 12期

关键词：

Antimicrobial de-escalation; Antimicrobial stewardship; Clinical stability; Community-acquired pneumonia; Microbiological tests; INFECTIOUS-DISEASES SOCIETY; BLOOD CULTURES; ADULTS; STEWARDSHIP; GUIDELINES; MANAGEMENT; DIAGNOSIS; THERAPY; CARE;

D O I：

10.1016/j.cmi.2022.06.021

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objectives: The usefulness of routine microbiological testing for rationalising antibiotic use in hospitalised patients with community-acquired pneumonia (CAP) continues to be a subject of debate. We aim to determine the effect of positive microbiological testing on antimicrobial de-escalation and clinical outcomes in CAP. Methods: A retrospective analysis of a prospectively collected cohort of non-immunosuppressed adults hospitalised with CAP was performed. The primary study outcome was antimicrobial de-escalation. Secondary outcomes included 30-day case-fatality rate, adverse events, and CAP recurrence. Adjustment for confounders was performed by inverse probability weighting propensity score, logistic regression, and cause-specific Cox model. Results: Of 3677 patients with CAP, 1924 (52.3%) had any positive microbiological test. Antimicrobial deescalation was performed in 648/1924 (33.7%) of patients with positive microbiological testing and in 179/1753 (10.2%) of those with non-positive results. When propensity score was entered into the multivariate analysis, positive microbiological testing (adjusted OR (AOR)], 2.59; 1.96e3.41) and clinical stability at day 3 (AOR 1.87; 1.45e2.10) were two of the main factors independently associated with antimicrobial de-escalation. After applying an adjusted cause-specific Cox model, antimicrobial deescalation was not associated with a higher 30-day case-fatality rate (adjusted hazard ratio (AHR), 0.44 (95% CI, 0.14e1.43)), higher frequency of adverse events (AHR, 0.77 (95% CI, 0.53e1.12)), or CAP recurrence (AHR, 0.65 (95% CI, 0.35e1.14)). Discussion: Antimicrobial de-escalation was more often performed in hospitalised patients with CAP who had positive microbiological tests than in those with non-positive results, and it did not adversely affect relevant clinical outcomes. Gabriela Abelenda-Alonso, Clin Microbiol Infect 2022;28:1602

引用

页码：1602 / 1608

页数：7

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