Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
Clin Microbiol Infect. 2022 Dec;28(12):1602-1608. doi: 10.1016/j.cmi.2022.06.021. Epub 2022 Jul 7.
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.
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.
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)).
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.
常规微生物检测在合理使用抗生素治疗社区获得性肺炎（CAP）住院患者中的作用仍存在争议。我们旨在确定微生物检测阳性对 CAP 患者抗菌药物降级和临床结局的影响。
对前瞻性收集的非免疫抑制成人 CAP 住院患者队列进行回顾性分析。主要研究结局为抗菌药物降级。次要结局包括 30 天病死率、不良事件和 CAP 复发。采用逆概率加权倾向评分、逻辑回归和特定原因 Cox 模型进行混杂因素校正。
在 3677 例 CAP 患者中，1924 例（52.3%）有任何阳性微生物学检测结果。在有阳性微生物学检测结果的 1924 例患者中，有 648 例（33.7%）进行了抗菌药物降级，在无阳性结果的 1753 例患者中，有 179 例（10.2%）进行了抗菌药物降级。当将倾向评分纳入多变量分析时，阳性微生物学检测（校正比值比（AOR），2.59；1.96-3.41）和第 3 天临床稳定（AOR 1.87；1.45-2.10）是与抗菌药物降级相关的两个主要因素。应用校正特定原因 Cox 模型后，抗菌药物降级与 30 天病死率增加无关（校正危害比（AHR），0.44（95%CI，0.14-1.43））、不良事件发生率增加（AHR，0.77（95%CI，0.53-1.12））或 CAP 复发（AHR，0.65（95%CI，0.35-1.14））无关。
与非阳性结果患者相比，有阳性微生物学检测结果的 CAP 住院患者更常进行抗菌药物降级，且不会对相关临床结局产生不利影响。
