Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia–A register-based cohort study. Issue 2 (August 2022)

• Record Type: Journal Article
• Authors: Athlin, Simon; Magnuson, Anders; Spindler, Carl; Hedlund, Jonas; Strålin, Kristoffer; Nauclér, Pontus
• Is Part Of: Journal of infection. Volume 85:Issue 2(2022)
• Page Start: 167
• Page End: 173
• Publication Date: 2022-08
• Subjects: Community-acquired pneumonia -- Urinary antigen test -- Streptococcus pneumoniae -- Broad-spectrum antibiotics -- Pneumococcus -- Antibiotic stewardship; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2022.05.021
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Routinely performing pneumococcal urinary antigen tests needs to be evalUATed. Performing urinary antigen test has little effect on antibiotic therapy in pneumonia. Mild pneumonia with a positive test is less frequently treated with broad-spectrum antibiotics. Severe pneumonia is treated with broad-spectrum antibiotics regardless of test result. 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 and 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.