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Bouzid D, Debray MP, Choquet C, de Montmollin E, Roussel M, Ferré V, Thy M, Le Hingrat Q, Loubet P. Diagnostic des pneumonies aiguës communautaires aux urgences et distinction entre étiologie virale ou bactérienne. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
La pandémie actuelle liée à l’émergence du SARSCoV-2 en 2019 a considérablement modifié la perception des médecins de l’impact des virus respiratoires et de leur rôle dans les pneumonies aiguës communautaires (PAC). Alors que plus de 25 % des tableaux de PAC chez l’adulte étaient d’origine virale, les virus respiratoires étaient souvent perçus comme des agents pathogènes peu graves. Devant le défi que représente encore à nos jours la documentation microbiologique d’une PAC, l’instauration d’un traitement empirique par antibiotiques est souvent réalisée aux urgences. La pandémie de COVID-19 a surtout mis en exergue le rôle déterminant de la biologie moléculaire et du scanner thoracique dans l’algorithme diagnostique de la PAC. En effet, un diagnostic rapide et fiable est la clé pour améliorer les mesures de précaution et réduire la prescription inutile d’antibiotiques. Du fait de prises en charges très différentes, il est nécessaire de distinguer l’étiologie virale de la bactérienne d’une PAC.
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Athlin S, Magnuson A, Spindler C, Hedlund J, Strålin K, Nauclér P. Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia: a register-based cohort study. J Infect 2022; 85:167-173. [PMID: 35618153 DOI: 10.1016/j.jinf.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 12/03/2021] [Accepted: 05/19/2022] [Indexed: 11/15/2022]
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 2011-2014 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.
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Affiliation(s)
- Simon Athlin
- Department of Infectious Diseases, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Carl Spindler
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hedlund
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kristoffer Strålin
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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Bouzid D, Zanella MC, Kerneis S, Visseaux B, May L, Schrenzel J, Cattoir V. Rapid diagnostic tests for infectious diseases in the emergency department. Clin Microbiol Infect 2020; 27:182-191. [PMID: 32120036 PMCID: PMC7129254 DOI: 10.1016/j.cmi.2020.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/23/2022]
Abstract
Background Rapid diagnostic tests (RDTs) for infectious diseases, with a turnaround time of less than 2 hours, are promising tools that could improve patient care, antimicrobial stewardship and infection prevention in the emergency department (ED) setting. Numerous RDTs have been developed, although not necessarily for the ED environment. Their successful implementation in the ED relies on their performance and impact on patient management. Objectives The aim of this narrative review was to provide an overview of currently available RDTs for infectious diseases in the ED. Sources PubMed was searched through August 2019 for available studies on RDTs for infectious diseases. Inclusion criteria included: commercial tests approved by the US Food and Drug Administration (FDA) or Conformité Européenne (CE) in vitro diagnostic devices with data on clinical samples, ability to run on fully automated systems and result delivery within 2 hours. Content A nonexhaustive list of representative commercially available FDA- or CE-approved assays was categorized by clinical syndrome: pharyngitis and upper respiratory tract infection, lower respiratory tract infection, gastrointestinal infection, meningitis and encephalitis, fever in returning travellers and sexually transmitted infection, including HIV. The performance of tests was described on the basis of clinical validation studies. Further, their impact on clinical outcomes and anti-infective use was discussed with a focus on ED-based studies. Implications Clinicians should be familiar with the distinctive features of each RDT and individual performance characteristics for each target. Their integration into ED work flow should be preplanned considering local constraints of given settings. Additional clinical studies are needed to further evaluate their clinical effectiveness and cost-effectiveness.
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Affiliation(s)
- D Bouzid
- Emergency Department, AP-HP, Bichat Claude Bernard Hospital, Paris, France; University of Paris, IAME, INSERM, Paris, France
| | - M-C Zanella
- Laboratory of Bacteriology, Division of Laboratory Medicine and Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - S Kerneis
- University of Paris, IAME, INSERM, Paris, France; AP-HP, Antimicrobial Stewardship Team, Hôpitaux Universitaires Paris Centre-Cochin, Paris, France; Pharmacoepidémiology and Infectious Diseases (Phemi), Pasteur Institute, Paris, France
| | - B Visseaux
- University of Paris, IAME, INSERM, Paris, France; AP-HP, Bichat Claude Bernard Hospital, Virology, Paris, France
| | - L May
- Department of Emergency Medicine, University of California-Davis, Sacramento, CA, USA
| | - J Schrenzel
- Laboratory of Bacteriology, Division of Laboratory Medicine and Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland; Genomic Research Laboratory, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - V Cattoir
- Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, Rennes, France; CNR de `la Résistance aux Antibiotiques (laboratoire associé'Entérocoques), Rennes, France; Unité Inserm U1230, Université de Rennes 1, Rennes, France.
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4
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Charton F, Conan PL, Le Floch H, Bylicki O, Gaspard W, Soler C, Margery J, Rivière F. Evaluation of pneumococcal urinary antigen testing for respiratory tract infection investigations. Med Mal Infect 2019; 50:57-62. [PMID: 31307675 DOI: 10.1016/j.medmal.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/10/2018] [Accepted: 06/24/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The pneumococcal urinary antigen test enables rapid bacteriological diagnosis in respiratory tract infections. The objective was to identify factors associated with a positive pneumococcal urinary antigen test result. PATIENTS AND METHODS This seven-year retrospective monocentric study was performed on consecutive patients presenting with respiratory tract infections reported as pneumococcal-positive. Epidemiological, biological, and radiological factors were analyzed, and severity scores were calculated. RESULTS A total of 223 patients were included. Significant associations were observed between positive test results and age over 65years (P=0.01), positive test results and immunosuppression factors (blood disease [25% Ag+ group vs. 4% Ag- group, P=0.001], immunosuppressive therapy [10% Ag+ group vs. 0% Ag- group, P=0.02]). Clinically, fever (64% Ag+ group vs. 42% Ag- group, P=0.01) and cough (46% Ag+ group vs. 19% Ag- group, P<0.01) were associated with a positive result, as were radiological alveolar opacities (67% Ag+ group vs. 44% Ag- group, P=0.01). High PSI score was associated with the Ag+ group (79% vs. 56% Ag- group, P=0.001). CONCLUSION Age, immunosuppressive factors, typical pneumococcal symptoms, and PSI scores were associated with a positive pneumococcal urinary antigen result.
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Affiliation(s)
- F Charton
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - P L Conan
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - H Le Floch
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - O Bylicki
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - W Gaspard
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - C Soler
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - J Margery
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - F Rivière
- Respiratory department, Percy military hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France.
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Viasus D, Calatayud L, McBrown MV, Ardanuy C, Carratalà J. Urinary antigen testing in community-acquired pneumonia in adults: an update. Expert Rev Anti Infect Ther 2019; 17:107-115. [PMID: 30618315 DOI: 10.1080/14787210.2019.1565994] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) continues to be a leading cause of hospitalization and mortality worldwide. Streptococcus pneumoniae and Legionella pneumophila remain the major etiological agents and are responsible for a significant proportion of CAP mortality. Among diagnostic tests for CAP, urine antigen detection of S. pneumoniae and L. pneumophila is widely accepted due to the simplicity of collection and the rapidity of the test results. Areas covered: This comprehensive review outlines the urinary antigen tests available, discusses their sensitivity and specificity, and assesses the usefulness of their results as the basis for targeted therapy. Expert commentary: There have been advances in urine antigen detection tests for patients with CAP. New methodologies show greater sensitivity, detect S. pneumoniae and L. pneumophila in a single test, and also detect pneumococcal serotypes. In addition, urine antigen detection tests have shown a high specificity, which means that a positive result practically indicates the causative pathogen of CAP. Therefore, a positive result can lead to a targeted therapy that is likely to improve patient outcomes and reduce the risk of resistance and adverse events. However, well-designed studies are needed to evaluate the usefulness of urine antigen detection tests with regard to clinical outcomes.
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Affiliation(s)
- Diego Viasus
- a Department of Medicine, Health Sciences Division , Universidad del Norte and Hospital Universidad del Norte , Barranquilla , Colombia
| | - Laura Calatayud
- b Department of Microbiology , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,c Research Network for Respiratory Diseases (CIBERES) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - María V McBrown
- a Department of Medicine, Health Sciences Division , Universidad del Norte and Hospital Universidad del Norte , Barranquilla , Colombia
| | - Carmen Ardanuy
- b Department of Microbiology , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,c Research Network for Respiratory Diseases (CIBERES) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - Jordi Carratalà
- d Department of Infectious Diseases , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,e Spanish Network for Research in Infectious Diseases (REIPI) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
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Dinh A, Duran C, Davido B, Lagrange A, Sivadon-Tardy V, Bouchand F, Beauchet A, Gaillard JL, Beaune S, Salomon J, Grenet J. Cost effectiveness of pneumococcal urinary antigen in Emergency Department: a pragmatic real-life study. Intern Emerg Med 2018; 13:69-73. [PMID: 27988829 DOI: 10.1007/s11739-016-1586-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/30/2016] [Indexed: 01/23/2023]
Abstract
Community-acquired pneumonia (CAP) is frequent and can be life-threatening. Streptococcus pneumoniae is the main bacteria involved, and is susceptible to penicillin A. Rapid microbiological diagnosis could then help reduce the antimicrobial spectrum. The pneumococcal urinary antigen (PUA) test is fast and easy to perform, but its impact on antimicrobial prescription and cost-effectiveness in emergency departments (ED) is not well known. We performed a pragmatic real life retrospective study in an adult ED to assess its usefulness: proportion of positive results, impact on antimicrobial prescriptions and cost-effectiveness. Over 3 years (from January 1st 2012 to December 31st 2014), 979 PUA tests were reutilized in our ED among 1224 patients who consulted for CAP; 51 (5.2%) were positive. Among them, 10 led to a modification of the antimicrobial treatment, but only 7 (14.3%) were in accordance with the results. The total cost of a PUA test is 27€. As only 7 PUA tests led to appropriate antimicrobial modification, we deemed that 972 had no impact, and the potential cost savings, if the test had not been used, would have been 26,244 € (972 × 27) during 3 years, that is 8748 € per year. Thus, it seems that the PUA test should not be generally used in the ED considering its low rate of positivity and the difficulties for physicians to adapt antibiotic treatment accordingly. This attitude change in utilization would lead to substantial cost savings.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
| | - Clara Duran
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Aurore Lagrange
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Valérie Sivadon-Tardy
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Frédérique Bouchand
- Pharmacy Department, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Alain Beauchet
- IT Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Sébastien Beaune
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jérôme Salomon
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Julie Grenet
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
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Mothes A, Léotard S, Nicolle I, Smets A, Chirio D, Rotomondo C, Tiger F, Del Giudice P, Perrin C, Néri D, Foucault C, Della Guardia M, Hyvernat H, Roger PM. Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy. Med Mal Infect 2016; 46:365-371. [DOI: 10.1016/j.medmal.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/28/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
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8
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Pneumococcal urinary antigen test: diagnostic yield and impact on antibiotic treatment. CLINICAL RESPIRATORY JOURNAL 2016; 11:999-1005. [DOI: 10.1111/crj.12453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 11/26/2015] [Accepted: 12/31/2015] [Indexed: 11/26/2022]
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9
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Severe community-acquired pneumonia and positive urinary antigen test for S. pneumoniae: amoxicillin is associated with a favourable outcome. Eur J Clin Microbiol Infect Dis 2015; 34:2455-61. [DOI: 10.1007/s10096-015-2503-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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Dirou S, Cazanave C. [Urine antigen testing: Indication and contribution to the treatment of community-acquired pneumonia]. Rev Mal Respir 2015. [PMID: 26204800 DOI: 10.1016/j.rmr.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Urinary antigen tests are quick and simple tests helping to provide an etiological diagnosis in community-acquired pneumonia. However, their prescription is sometimes excessive and performed in unjustified situations. The therapeutic benefit is limited. Indeed, studies show that appropriate antibiotic therapy based on the result of urinary antigen tests does not improve the cost and the patient survival compared to empirical antibiotic therapy. One must be careful before antibiotic therapy reduction based on the sole negative result of urinary antigen test. Legionella urinary antigen test is the most commonly method used for the diagnosis of legionellosis but must be prescribed in a specific clinical context. Streptococcus pneumoniae urinary antigen test is especially interesting in the epidemiological surveillance of pneumococcal community-acquired pneumonia.
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Affiliation(s)
- S Dirou
- Service de pneumologie, l'institut du thorax, hôpital G.- et R.- Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France.
| | - C Cazanave
- Service de maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
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Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric). Intensive Care Med 2015; 41:1181-96. [PMID: 26077053 DOI: 10.1007/s00134-015-3853-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/28/2015] [Indexed: 02/07/2023]
Abstract
Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. The urgency of the situation and the conviction that practices should change led the Société de Réanimation de Langue Française (SRLF) and the Société Française d'Anesthésie et de Réanimation (SFAR) to set up a panel of experts from various disciplines. These experts met for the first time at the end of 2012 and have since met regularly to issue the following 67 recommendations, according to the rigorous GRADE methodology. Five fields were explored: i) the link between the resistance of bacteria and the use of antibiotics in intensive care; ii) which microbiological data and how to use them to reduce antibiotic consumption; iii) how should antibiotic therapy be chosen to limit consumption of antibiotics; iv) how can antibiotic administration be optimized; v) review and duration of antibiotic treatments. In each institution, the appropriation of these recommendations should arouse multidisciplinary discussions resulting in better knowledge of local epidemiology, rate of antibiotic use, and finally protocols for improving the stewardship of antibiotics. These efforts should contribute to limit the emergence of resistant bacteria.
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Batard E, Lecadet N, Goffinet N, Hardouin JB, Lepelletier D, Potel G, Montassier E. High variability among Emergency Departments in 3rd-generation cephalosporins and fluoroquinolones use for community-acquired pneumonia. Infection 2015; 43:681-9. [PMID: 25998004 DOI: 10.1007/s15010-015-0793-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Fluoroquinolones and 3rd-generation cephalosporins that are prescribed for pneumonia may be avoided and replaced by a penicillin in some cases. We aimed to determine if the proportion of patients treated for pneumonia with a cephalosporin, a fluoroquinolone or both varies among Emergency Departments (EDs), and to estimate the proportion of avoidable prescriptions. METHODS This was a retrospective study of patients treated for pneumonia in eight French EDs, and subsequently hospitalized in non-ICU wards. Third-generation cephalosporins or respiratory fluoroquinolones were presumed unavoidable if they met both criteria: (1) age ≥65 years or comorbid condition; and (2) allergy or intolerance to penicillin, or failure of penicillin, or previous treatment with penicillin, or for fluoroquinolones only, suspected legionellosis. RESULTS We included 832 patients. Thirty-four percent (95 % CI, 31-38 %) of patients were treated with a cephalosporin, a respiratory fluoroquinolone or both (range among EDs 19-44 %). Four EDs were independent risk factors for prescription of a cephalosporin, a fluoroquinolone or both [adjusted OR, 2.27 (1.64-3.15)], as were immune compromise [aOR 2.54 (1.56-4.14)], antibacterial therapy started before arrival in the ED [aOR 3.32 (2.30-4.81)], REA-ICU class III or IV [aOR 1.93 (1.15-3.23)], PSI class V [aOR 1.49 (1.00-2.20)], fluid resuscitation [aOR 3.98 (2.49-6.43)] and non-invasive ventilation in the ED [aOR, 7.18 (1.7-50.1)]. Treatment with a cephalosporin, a fluoroquinolone or both was avoidable in 67 % (62-73 %) of patients. CONCLUSION Cephalosporins and fluoroquinolones use in pneumonia is highly variable among EDs. The majority of these prescriptions are avoidable. Antibiotic stewardship programs should be implemented to restrict their use in EDs.
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Affiliation(s)
- Eric Batard
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France. .,Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France.
| | - Nathalie Lecadet
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - Nicolas Goffinet
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - Jean-Benoit Hardouin
- Faculté de Médecine and Pharmacie, Université de Nantes, EA 4275 SPHERE Biostatistics Pharmacoepidemiology and Human Science Research Team, 1 rue Gaston-Veil, 44000, Nantes, France
| | | | - Didier Lepelletier
- Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France.,Department of Microbiology and Infection Control, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France
| | - Gilles Potel
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France.,Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France
| | - Emmanuel Montassier
- Emergency Department, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000, Nantes, France.,Faculté de Médecine and Pharmacie, Université de Nantes, EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, 1 rue Gaston-Veil, 44000, Nantes, France
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13
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Stratégies de réduction de l’utilisation des antibiotiques à visée curative en réanimation (adulte et pédiatrique). MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0916-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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14
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Systematic review and meta-analysis of a urine-based pneumococcal antigen test for diagnosis of community-acquired pneumonia caused by Streptococcus pneumoniae. J Clin Microbiol 2013; 51:2303-10. [PMID: 23678060 DOI: 10.1128/jcm.00137-13] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Standard culture methods for diagnosis of Streptococcus pneumoniae pneumonia take at least 24 h. The BinaxNOW urine-based test for S. pneumoniae (BinaxNOW-SP) takes only 15 min to conduct, potentially enabling earlier diagnosis and targeted treatment. This study was conducted to assess whether the use of BinaxNOW-SP at the time of hospital admission would provide adequate sensitivity and specificity for diagnosis of community-acquired pneumonia (CAP) in adult patients. We searched PubMed, EMBASE/OVID, Cochrane Collaboration, Centre for Reviews and Dissemination, INAHTA, and CADTH for diagnostic or etiologic studies of hospitalized predominately adult patients with clinically defined CAP that reported the diagnostic performance of BinaxNOW-SP versus cultures. Two authors independently extracted study details and diagnostic two-by-two tables. We found that 27 studies met our inclusion criteria, and three different reference standards were used between them. A bivariate meta-analysis of 12 studies using a composite of culture tests as the reference standard estimated the sensitivity of BinaxNOW-SP as 68.5% (95% credibility interval [CrI], 62.6% to 74.2%) and specificity as 84.2% (95% CrI, 77.5% to 89.3%). A meta-analysis of all 27 studies, adjusting for the imperfect and variable nature of the reference standard, gave a higher sensitivity of 74.0% (CrI, 66.6% to 82·3%) and specificity of 97.2% (CrI, 92.7% to 99.8%). The analysis showed substantial heterogeneity across studies, which did not decrease with adjustment for covariates. We concluded that the higher pooled sensitivity (compared to culture) and high specificity of BinaxNOW-SP suggest it would be a useful addition to the diagnostic workup for community-acquired pneumonia. More research is needed regarding the impact of BinaxNOW-SP on clinical practice.
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Abstract
We evaluated the usefulness of a rapid immunochromatographic pneumococcal urinary antigen test (UAT) for the diagnosis of pneumonia over a period of five years. The UAT was positive in 32 (2.3%) urine samples obtained from 1414 patients. In 46 of these 1414 patients results of UAT and/or sputum/pleural fluid culture and/or blood culture and/or procalcitonin levels were available and therefore the study was concentrated on these patients. A concordance between UAT positivity and the presence of Streptococcus pneumoniae in the sputum was observed in only 4 of 46 (8.7%) patients for which both urine and sputum samples were analyzed. A discordant result (UAT positive and absence of S. pneumoniae in sputum samples) was recorded in 8 of 46 (17.4 %) patients. UAT negative results with sputum culture positive for S. pneumoniae were recorded in 28.3% of patients. In 20 patients, UAT tested positive but sputum culture was not performed. A concordance between UAT positivity and the isolation of S. pneumoniae from blood was seen in 2 of 46 patients whereas a discordant result (UAT positive and blood culture negative) was seen in 12 (26.1%) patients. A concordance between the UAT and high levels (≥2ng/ml) of procalcitonin was observed in 4 out of 46 patients, whereas a positive UAT result and a procalcitonin negative result were observed in 2 patients. In our experience the UAT allows the detection of the etiological agent of pneumonia, and also when sputum and/or blood cultures are negative for S. pneumoniae, when the clinical picture is suggestive of alveolar pneumonia.
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Engel MF, Velzen M, Hoepelman AIM, Thijsen S, Oosterheert JJ. Positive urinary antigen tests for Streptococcus pneumoniae in community-acquired pneumonia: a 7-year retrospective evaluation of health care cost and treatment consequences. Eur J Clin Microbiol Infect Dis 2012; 32:485-92. [DOI: 10.1007/s10096-012-1761-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/08/2012] [Indexed: 11/29/2022]
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Drieux L. Caractéristiques des infections respiratoires basses chez les sujets âgés. ANTIBIOTIQUES 2010; 12:190-196. [PMID: 32288526 PMCID: PMC7146795 DOI: 10.1016/j.antib.2010.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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