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

  • Esther WittermansEmail author
  • Stefan M. T. Vestjens
  • Willem Jan W. Bos
  • Jan C. Grutters
  • Ewoudt M. W. van de Garde
  • Bart J. M. Vlaminckx
Original Article


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.


Bacterial pneumonia Antimicrobial stewardship Polymerase chain reaction 



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.

Compliance with ethical standards

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

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10096_2019_3561_MOESM1_ESM.docx (24 kb)
Supplementary Table 1 (DOCX 23 kb)


  1. 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. CrossRefGoogle Scholar
  2. 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:
  3. 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. CrossRefGoogle Scholar
  4. 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. CrossRefGoogle Scholar
  5. 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. CrossRefGoogle Scholar
  6. 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. Google Scholar
  7. 7.
    Paterson DL (2004) “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 38:S341–S345CrossRefGoogle Scholar
  8. 8.
    Musher DM, Thorner AR (2014) Community-acquired pneumonia. N Engl J Med 371:1619–1628. CrossRefGoogle Scholar
  9. 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.$FILE/CAP_SWAB_2017-DEF_R5.pdf. Accessed 4 Jan 2019
  10. 10.
    File TM Jr (2011) New diagnostic tests for pneumonia: what is their role in clinical practice? Clin Chest Med 32:417–430. CrossRefGoogle Scholar
  11. 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. CrossRefGoogle Scholar
  12. 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. CrossRefGoogle Scholar
  13. 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. CrossRefGoogle Scholar
  14. 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. CrossRefGoogle Scholar
  15. 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. CrossRefGoogle Scholar
  16. 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):90–101Google Scholar
  17. 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 CrossRefGoogle Scholar
  18. 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. CrossRefGoogle Scholar
  19. 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. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineSt. Antonius HospitalNieuwegeinthe Netherlands
  2. 2.Department of Medical Microbiology and ImmunologySt. Antonius HospitalNieuwegeinthe Netherlands
  3. 3.Department of Internal Medicine – Division NephrologyLeiden University Medical CentreLeidenthe Netherlands
  4. 4.Interstitial Lung Diseases Centre of Excellence, Department of PulmonologySt. Antonius HospitalNieuwegeinthe Netherlands
  5. 5.Division of Heart and LungsUniversity Medical Centre UtrechtUtrechtthe Netherlands
  6. 6.Department of Clinical PharmacySt. Antonius HospitalNieuwegeinthe Netherlands
  7. 7.Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of ScienceUtrecht UniversityUtrechtthe Netherlands

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