Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis. (December 2022)

• Record Type: Journal Article
• Authors: Abelenda-Alonso, Gabriela; Rombauts, Alexander; Gudiol, Carlota; García-Lerma, Esther; Pallarés, Natalia; Ardanuy, Carmen; Calatayud, Laura; Niubó, Jordi; Tebé, Cristian; Carratalà, Jordi
• Is Part Of: Clinical microbiology and infection. Volume 28:Number 12(2022)
• Page Start: 1602
• Page End: 1608
• Publication Date: 2022-12
• Subjects: Antimicrobial de-escalation -- Antimicrobial stewardship -- Clinical stability -- Community-acquired pneumonia -- Microbiological tests; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2022.06.021
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: 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 de-escalation 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; 1.96–3.41) and clinical stability at day 3 (AOR 1.87; 1.45–2.10) were two of the main factors independently associated with antimicrobial de-escalation. After applying an adjusted cause-specific Cox model, antimicrobial de-escalation was not associated with a higher 30-day case-fatality rate (adjusted hazard ratio (AHR), 0.44 (95% CI, 0.14–1.43)), higher frequency of adverse events (AHR, 0.77 (95% CI, 0.53–1.12)), or CAP recurrence (AHR, 0.65 (95% CI, 0.35–1.14)). 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.