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

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 c...

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Autores: Abelenda Alonso, Gabriela, Rombauts, Alexander, Gudiol González, Carlota, García-Lerma, Esther, Pallarès, Natàlia, Ardanuy Tisaire, María Carmen, Calatayud, Laura, Niubó, Jordi, Tebé, Cristian, Carratalà, Jordi
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/194134
Acceso en línea:https://hdl.handle.net/2445/194134
Access Level:acceso abierto
Palabra clave:Pneumònia
Medicaments antibacterians
Microbiologia
Pneumonia
Antibacterial agents
Microbiology
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spelling Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysisAbelenda Alonso, GabrielaRombauts, AlexanderGudiol González, CarlotaGarcía-Lerma, EstherPallarès, NatàliaArdanuy Tisaire, María CarmenCalatayud, LauraNiubó, JordiTebé, CristianCarratalà, JordiPneumòniaMedicaments antibacteriansMicrobiologiaPneumoniaAntibacterial agentsMicrobiologyObjectives: 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.European Society of Clinical Microbiology and Infectious Diseases2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/194134Articles publicats en revistes (Patologia i Terapèutica Experimental)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1016/j.cmi.2022.06.021Clinical Microbiology and Infection, 2022, vol. 28, num. 12, p. 1602-1608https://doi.org/10.1016/j.cmi.2022.06.021cc by (c) Abelenda Alonso, Gabriela et al., 2022http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1941342026-05-27T06:46:51Z
dc.title.none.fl_str_mv Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
title Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
spellingShingle Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
Abelenda Alonso, Gabriela
Pneumònia
Medicaments antibacterians
Microbiologia
Pneumonia
Antibacterial agents
Microbiology
title_short Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
title_full Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
title_fullStr Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
title_full_unstemmed Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
title_sort Effect of positive microbiological testing on antibiotic de-escalation and outcomes in community-acquired pneumonia: a propensity score analysis
dc.creator.none.fl_str_mv Abelenda Alonso, Gabriela
Rombauts, Alexander
Gudiol González, Carlota
García-Lerma, Esther
Pallarès, Natàlia
Ardanuy Tisaire, María Carmen
Calatayud, Laura
Niubó, Jordi
Tebé, Cristian
Carratalà, Jordi
author Abelenda Alonso, Gabriela
author_facet Abelenda Alonso, Gabriela
Rombauts, Alexander
Gudiol González, Carlota
García-Lerma, Esther
Pallarès, Natàlia
Ardanuy Tisaire, María Carmen
Calatayud, Laura
Niubó, Jordi
Tebé, Cristian
Carratalà, Jordi
author_role author
author2 Rombauts, Alexander
Gudiol González, Carlota
García-Lerma, Esther
Pallarès, Natàlia
Ardanuy Tisaire, María Carmen
Calatayud, Laura
Niubó, Jordi
Tebé, Cristian
Carratalà, Jordi
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pneumònia
Medicaments antibacterians
Microbiologia
Pneumonia
Antibacterial agents
Microbiology
topic Pneumònia
Medicaments antibacterians
Microbiologia
Pneumonia
Antibacterial agents
Microbiology
description 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.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/194134
url https://hdl.handle.net/2445/194134
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1016/j.cmi.2022.06.021
Clinical Microbiology and Infection, 2022, vol. 28, num. 12, p. 1602-1608
https://doi.org/10.1016/j.cmi.2022.06.021
dc.rights.none.fl_str_mv cc by (c) Abelenda Alonso, Gabriela et al., 2022
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Abelenda Alonso, Gabriela et al., 2022
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv European Society of Clinical Microbiology and Infectious Diseases
publisher.none.fl_str_mv European Society of Clinical Microbiology and Infectious Diseases
dc.source.none.fl_str_mv Articles publicats en revistes (Patologia i Terapèutica Experimental)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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