Regional Centre for Disease Control in Central Norway Regional Health Authority, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway.
Central Norway Hospital Pharmacy Trust, Ålesund, Norway.
BMC Infect Dis. 2022 Mar 2;22(1):203. doi: 10.1186/s12879-022-07199-4.
Studies on aetiology of community-acquired pneumonia (CAP) vary in terms of microbial sampling methods, anatomical locations, and laboratory analyses, since no gold standard exists. In this large, multicentre, retrospective, regional study from Norway, our primary objective was to report the results of a strategic diagnostic stewardship intervention, targeting diagnostic yield from lower respiratory tract sampling. The secondary objective was to report hospitalized CAP aetiology and the diagnostic yield of various anatomical sampling locations.
Medical records from cases diagnosed with hospitalized CAP were collected retrospectively from March throughout May for three consecutive years at six hospitals. Between year one and two, we launched a diagnostic stewardship intervention at the emergency room level for the university teaching hospital only. The intervention was multifaceted aiming at upscaling specimen collection and enhancing collection techniques. Year one at the interventional hospital and every year at the five other emergency hospitals were used for comparison.
Of the 1280 included cases of hospitalized CAP, a microbiological diagnosis was established for 29.1% among 1128 blood cultures and 1444 respiratory tract specimens. Blood cultures were positive for a pathogenic respiratory tract microbe in 4.9% of samples, whereas upper and lower respiratory tract samples overall provided a probable microbiological diagnosis in 21.3% and 47.5%, respectively. Expectorated or induced sputum overall provided aetiology in 51.7% of the samples. At the interventional hospital, the number of expectorated or induced sputum samples were significantly increased, and diagnostic yield from expectorated or induced sputum was significantly enhanced from 41.2 to 62.0% after the intervention (p = 0.049). There was an over-representation of samples from the interventional hospital during the study period. Non-typeable Haemophilus influenza and Streptococcus pneumoniae accounted for 25.3% and 24.7% of microbiologically confirmed cases, respectively.
Expectorated or induced sputum outperformed other sampling methods in providing a reliable microbiological diagnosis for hospitalized CAP. A diagnostic stewardship intervention significantly improved diagnostic yield of lower respiratory tract sampling.
社区获得性肺炎（CAP）的病因研究在微生物采样方法、解剖部位和实验室分析方面存在差异，因为没有金标准。在这项来自挪威的大型、多中心、回顾性、区域性研究中，我们的主要目标是报告一项战略性诊断管理干预措施的结果，该措施针对下呼吸道采样的诊断效果。次要目标是报告住院 CAP 的病因以及各种解剖采样部位的诊断效果。
从三年中的三月份到五月份，连续收集六家医院诊断为住院 CAP 的病例的病历进行回顾性分析。在第一年和第二年之间，我们仅在大学教学医院的急诊室一级启动了诊断管理干预措施。该干预措施是多方面的，旨在扩大标本采集并提高采集技术。干预医院的第一年和其他五家急诊医院的每一年都被用来进行比较。
在 1280 例住院 CAP 患者中，1128 份血培养和 1444 份呼吸道标本中，有 29.1%确定了微生物学诊断。血液培养对呼吸道病原体微生物的阳性率为 4.9%，而上、下呼吸道标本的总体可能微生物学诊断率分别为 21.3%和 47.5%。总体而言，咳出或诱导痰提供了 51.7%的病因。在干预医院，咳出或诱导痰的样本数量显著增加，并且在干预后，从咳出或诱导痰中获得的诊断效果从 41.2%显著提高到 62.0%（p=0.049）。在研究期间，干预医院的样本数量过多。不可分型流感嗜血杆菌和肺炎链球菌分别占微生物学确诊病例的 25.3%和 24.7%。
咳出或诱导痰在为住院 CAP 提供可靠的微生物学诊断方面优于其他采样方法。诊断管理干预措施显著提高了下呼吸道采样的诊断效果。
