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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

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.

Keywords

Bacterial pneumonia Antimicrobial stewardship Polymerase chain reaction 

Notes

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.

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)

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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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