Greenfield Adam, Marsh Kassandra, Siegfried Justin, Zacharioudakis Ioannis, Ahmed Nabeela, Decano Arnold, Aguero-Rosenfeld Maria E, Inglima Kenneth, Papadopoulos John, Dubrovskaya Yanina
Department of Pharmacy, New York University Langone Health, New York, New York, USA.
Division of Infectious Diseases, Department of Medicine, New York University Langone Health, New York, New York, USA.
Open Forum Infect Dis. 2021 Oct 22;9(1):ofab522. doi: 10.1093/ofid/ofab522. eCollection 2022 Jan.
Limited data support use of pneumococcal urinary antigen testing (PUAT) for patients with community-acquired pneumonia (CAP) as an antimicrobial stewardship tool. At our institution, CAP guidelines and admission order set were standardized to include universal PUAT.
This was a retrospective study of adults hospitalized in 2019 who had PUAT performed. We compared incidence and timing of de-escalation in PUAT- positive vs -negative groups and described patients' outcomes.
We evaluated 910 patients, 121 (13.3%) of whom were PUAT positive. No difference in baseline characteristics, including severity of illness, was observed between groups. Initial de-escalation occurred in 82.9% and 81.2% of PUAT-positive and -negative patients, respectively ( = .749). Median time to de-escalation was shorter in the PUAT-positive group (1 [interquartile range {IQR}, 0-2] day vs 1 [IQR, 1-2] day, = .01). Within 24 hours of PUAT, more patients in the PUAT-positive group had atypical coverage discontinued (61.3% vs 47.2%, = .026) without difference in methicillin-resistant (MRSA) agent discontinuation (or antipseudomonal de-escalation). Among the PUAT-positive group, unadjusted analysis demonstrated shorter median length of stay in patients who were de-escalated compared to those who were not (6 [IQR, 4-10] vs 8 [IQR, 7-12] days, = .0005), without difference in the incidence of , in-hospital mortality, or 30-day infection-related readmission.
We observed earlier de-escalation in the PUAT-positive group. This seems to be due to discontinuation of atypical rather than anti-MRSA or antipseudomonal coverage. Further antimicrobial stewardship interventions are warranted.
有限的数据支持将肺炎球菌尿抗原检测（PUAT）用于社区获得性肺炎（CAP）患者，作为一种抗菌药物管理工具。在我们机构，CAP指南和入院医嘱集被标准化，以纳入普遍的PUAT。
这是一项对2019年住院并接受PUAT检测的成年人进行的回顾性研究。我们比较了PUAT阳性组和阴性组降阶梯治疗的发生率和时间，并描述了患者的结局。
我们评估了910例患者，其中121例（13.3%）PUAT呈阳性。两组之间在包括疾病严重程度在内的基线特征方面未观察到差异。初始降阶梯治疗分别发生在82.9%的PUAT阳性患者和81.2%的PUAT阴性患者中（P = 0.749）。PUAT阳性组降阶梯治疗的中位时间较短（1天[四分位间距{IQR}，0 - 2天]对1天[IQR，1 - 2天]，P = 0.01）。在PUAT检测后24小时内，PUAT阳性组更多患者的非典型覆盖药物停用（61.3%对47.2%，P = 0.026），而耐甲氧西林金黄色葡萄球菌（MRSA）药物停用（或抗假单胞菌降阶梯治疗）无差异。在PUAT阳性组中，未经调整的分析显示，与未进行降阶梯治疗的患者相比，进行降阶梯治疗的患者中位住院时间较短（6天[IQR，4 - 10天]对8天[IQR，7 - 12天]，P = 0.0005），在菌血症发生率、住院死亡率或30天感染相关再入院方面无差异。
我们观察到PUAT阳性组降阶梯治疗更早。这似乎是由于非典型覆盖药物的停用，而非抗MRSA或抗假单胞菌覆盖药物的停用。有必要进一步采取抗菌药物管理干预措施。
