Clinical Diagnosis, Viral PCR, and Antibiotic Utilization in Community-Acquired Pneumonia

Abstract

We evaluated the intensity of antibiotic therapy in patients in whom the etiology of community-acquired pneumonia (CAP) was determined using newly available diagnostic techniques. For 1 year, we studied all patients admitted for findings consistent with CAP. Sputum and blood cultures, urinary pneumococcal and Legionella antigens, and viral polymerase chain reaction (PCR) were studied prospectively. Patients were stratified based on the final diagnoses: proven bacterial, presumptive bacterial, viral, fungal, undetermined, and uninfected. We determined the number of antibiotics given, duration of antibiotic therapy, and intensity of antibiotic use determined by antibiotic-days defined as the sum, in each patient, of all antibiotics given for CAP and the number of days given. Median duration and intensity of antibiotics were 12 and 18 days for proven, and 13 and 16.5 days for presumed bacterial CAP (P > 0.9). When positive viral PCR results were not disclosed to primary care physicians, antibiotic use was similar to that in bacterial CAP. However, in 11 cases, when positive viral PCR results were disclosed, duration and intensity of antibiotic use were reduced to 7 and 9 days, respectively (P = 0.05 and 0.08, respectively). Antibiotic use was similar in patients with bacterial pneumonia and those judged on clinical grounds to have likely nonbacterial infection. Despite obvious differences in clinical syndromes and final diagnoses, the intensity of antibiotic therapy was similar in all groups of patients admitted for CAP with the exception of those who were uninfected and whose primary care physicians were informed of a positive viral PCR.

The rapid diagnosis of viral respiratory tract infections and its impact on antimicrobial stewardship programs

“…This finding was explained by being a new test [13]. In another study, Afzal et al [14] reported that a positive result for MRT decreased antibiotic use duration and prescription rate but the decrease in antibiotic prescription was not statistically significant. Timbrook et al [15] studied MRT in combination with PCT and concluded that a lower level of PCT and detection of virus by MRT were not associated with decreased use of antibiotics in RTIs, but in another study, a lower level of PCT in combination with detection of virus was found to be associated with shortened duration of antibiotic usage [16].…”

Multiplex Respiratory Virus Testing for Antimicrobial Stewardship: A Prospective Assessment of Antimicrobial Use and Clinical Outcomes Among Hospitalized Adults

“…Studies conducted among pediatric populations have shown that rapid viral testing generally contributes to reducing antibiotic use [8][9][10], but those among adult patients have yielded conflicting results. Small reductions in antibiotic use, shorter durations of hospitalization, and lower overall costs were noted in some studies when test results were communicated to physicians rapidly [11][12][13][14]. However, these were limited by small sample sizes, by comparisons only to historical controls, or by the fact that they only included outpatients-making it difficult to extrapolate their results to acute care hospital settings.…”

Community-acquired pneumonia

“…According to research, meta analysis comparing treatments, which lasted 7 days or less, as compared to treatments of 8 days or longer didn`t show differences in outcomes 14 . All the same, doctors have gradually increased treatment duration from 10 to 14 days 15,16 .…”