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Ito A, Ishida T, Tachibana H, Nakanishi Y, Yamazaki A, Washio Y. Predictors and usefulness of targeted therapy for pneumococcal community-acquired pneumonia diagnosed by the urinary antigen test: a prospective, observational cohort study. Diagn Microbiol Infect Dis 2021; 101:115457. [PMID: 34271234 DOI: 10.1016/j.diagmicrobio.2021.115457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/24/2022]
Abstract
The aim of the present study was to investigate the predictors of targeted therapy (TT) for pneumococcal community-acquired pneumonia (PCAP) with a positive urinary antigen test (UAT) and compare the outcomes with those of nontargeted therapy. This prospective cohort study enrolled consecutive PCAP patients with a positive UAT who were hospitalized at Kurashiki Central Hospital from October 2010 to November 2019. A total of 286 patients were included. Of them, 56 patients (19.6%) were included in the TT group. On multivariate analysis, identification of Gram-positive diplococci by Gram stain (OR [95% CI]: 2.46 [1.32-4.63]) was a positive predictor, whereas aspiration pneumonia (0.17 [0.03-0.59]) and CURB-65 score (0.59 [0.42-0.81]) were negative predictors of TT. Initial treatment failure and 30-day mortality were not significantly different. The UAT is not used enough for TT, and TT for PCAP did not have worse outcomes.
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Key Words
- Community-acquired pneumonia
- pneumococcal pneumonia
- targeted therapy
- urinary antigen test. Abbreviations: Binax, Binax NOW S. pneumoniae urinary antigen test kit CAP, community-acquired pneumonia CURB-65, confusion, urea >7 mmol/L, respiratory rate ≥30 breaths per minute, low blood pressure (systolic <90 mm Hg or diastolic ≤60 mm Hg), and age ≥65 years IPTW, inverse probability of treatment weighting PSI, Pneumonia Severity Index PUAT, pneumococcal urinary antigen test UAT, urinary antigen test
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, Joyo, Kyoto, Japan
| | - Yosuke Nakanishi
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; Department of Respiratory Medicine, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Souhail B, Charlot P, Deroudilhe G, Coblentz Y, Pierquet G, Gimel P, Challut N, Levent T, Cusumano S, Dautezac V, Roger PM. Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis. Eur J Clin Microbiol Infect Dis 2020; 39:2077-2083. [PMID: 32591897 DOI: 10.1007/s10096-020-03953-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/15/2020] [Indexed: 12/23/2022]
Abstract
Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care.
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Affiliation(s)
| | - Patrick Charlot
- Elsan, Clinique Inkermann, 84 Rte d'Aiffres, 79000, Niort, France
| | - Gilles Deroudilhe
- Elsan, Clinique Saint Augustin, 114 Ave d'Arès, 33000, Bordeaux, France
| | - Yves Coblentz
- Elsan, Clinique Inkermann, 84 Rte d'Aiffres, 79000, Niort, France
| | - Gregory Pierquet
- Elsan, Clinique Saint Augustin, 114 Ave d'Arès, 33000, Bordeaux, France
| | - Pierre Gimel
- Elsan, Clinique Saint-Roch 5 Rue Ambroise Croizat, 66330, Cabestany, France
| | - Nathalie Challut
- Elsan, Clinique Saint-Roch 5 Rue Ambroise Croizat, 66330, Cabestany, France
| | - Thierry Levent
- Elsan, Clinique Vauban, 10 Avenue Vauban, 59300, Valenciennes, France
| | - Stéphane Cusumano
- Elsan, Clinique du Sidobre, Chemin de St Hyppolyte, 81100, Castres, France
| | - Véronique Dautezac
- Elsan, Clinique du Sidobre, Chemin de St Hyppolyte, 81100, Castres, France
| | - Pierre-Marie Roger
- Réso-Infectio-PACA-Est, Nice, France.,Elsan, Clinique Les Fleurs,, Avenue Frédéric Mistral, 83190, Ollioules, France.,Faculté de Médecine, Université Côte d'Azur, 28 Avenue de Valombrose, 06107, Nice, France
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Roger PM, Peyraud I, Vitris M, Romain V, Bestman L, Blondel L, Gras H, Hauchart C, Morandi V, Rancezot A, Borredon G, Dautezac V. Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study. J Antimicrob Chemother 2020; 75:747-755. [PMID: 31851314 DOI: 10.1093/jac/dkz490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. METHODS Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. RESULTS We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82-5.92 and 2.18, 95% CI 1.38-3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06-0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34-0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was -16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). CONCLUSIONS STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.
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Affiliation(s)
- Pierre-Marie Roger
- Infectiologie, Clinique Les Fleurs, 332 ave Frédéric Mistral, 83110 Ollioules, France.,Faculté de Médecine, Université Côte d'Azur, Nice, France
| | - Ingrid Peyraud
- Pharmacie, Clinique Inkermann, 84 Rte d'Aiffres, 79000 Niort, France
| | - Michel Vitris
- Hygiène, Clinique du Pont de Chaume, 330 ave Marcel Unal, 82000, Montauban, France
| | - Valérie Romain
- Anesthésie-Réanimation et Hygiène, Pôle Santé Atlantique, Ave Claude Bernard, 44819 St Herblain, France
| | - Laura Bestman
- Service Qualité, Clinique St Louis, 1 rue Basset, 78300 Poissy, France
| | - Lionel Blondel
- Hygiène, Clinique l'Orangerie, 29 allée de la Robertsau, 67000 Strasbourg, France
| | - Hélène Gras
- Pharmacie, Clinique Les Lauriers, 147 rue Jean Giono, 83600 Fréjus, France
| | - Christine Hauchart
- Pharmacie, Clinique St Claude, 1, Bd du Dr Schweitzer, 02100 Saint Quentin, France
| | - Véronique Morandi
- Pharmacie et Hygiène, Clinique St Roch, rue Ambroise Croizat, 66330 Cabestany, France
| | - Agnès Rancezot
- Pharmacie, Clinique Médicale et Cardiologique d'Aressy, rue de Lourdes, 64320 Aressy, France
| | - Gaelle Borredon
- Pharmacie, Clinique Ormeau, 12 chemin de l'Ormeau, 65000 Tarbes, France
| | - Véronique Dautezac
- Pharmacie, Clinique du Sidobre, chemin de St Hyppolyte, 81100 Castres, France
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Roger PM, Michélangeli C, Girard D, Etienne P, Borredon G, Dautezac V, Keita-Perse O, Del Giudice P. Streamlined guidelines for antibiotic therapies are required for greater efficacy. Med Mal Infect 2019; 49:363-366. [PMID: 30826173 DOI: 10.1016/j.medmal.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/04/2019] [Indexed: 01/26/2023]
Affiliation(s)
- P M Roger
- Infectiologie, groupe Elsan, 75008 Paris, France; Faculté de médecine, université Côte-d'Azur, 06000 Nice, France; Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France.
| | - C Michélangeli
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Infectiologie, centre hospitalier universitaire de Nice, 06000 Nice, France
| | - D Girard
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Laboratoire Cerballiance, 83190 Ollioules, France
| | - P Etienne
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Centre de lutte contre la tuberculose, centre hospitalier universitaire de Nice, 06000 Nice, France
| | - G Borredon
- Pharmacie, clinique Ormeau, 65000 Tarbes, France
| | - V Dautezac
- Pharmacie, clinique du Sidobre, 81100 Castres, France
| | - O Keita-Perse
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Service d'hygiène hospitalière, hôpital Princesse-Grâce, 98000 Monaco
| | - P Del Giudice
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Dermatologie et infectiologie, hôpital de Fréjus-St-Raphael, 83608 Fréjus, France
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Community-acquired pneumonia requiring hospitalization: rational decision making and interpretation of guidelines. Curr Opin Pulm Med 2018; 23:204-210. [PMID: 28198726 DOI: 10.1097/mcp.0000000000000371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review focuses on the evidence base for guideline recommendations on the diagnosis, the optimal choice, timing and duration of empirical antibiotic therapy, and the use of microbiological tests for patients hospitalized with community-acquired pneumonia (CAP): issues for which guidelines are frequently used as a quick reference. Furthermore, we will discuss possibilities for future research in these topics. RECENT FINDINGS Many national and international guideline recommendations, even on critical elements of CAP management, are based on low-to-moderate quality evidence. SUMMARY The diagnosis and management of CAP has hardly changed for decades. The recommendation to cover atypical pathogens in all hospitalized CAP patients is based on observational studies only and is challenged by two recent trials. The following years, improved diagnostic testing, radiologically by low-dose Computed Tomography or ultrasound and/or microbiologically by point-of-care multiplex PCR, has the potential to largely influence the choice and start of antibiotic therapy in hospitalized CAP patients. Rapid microbiological testing will hopefully improve antibiotic de-escalation or early pathogen-directed therapy, both potent ways of reducing broad-spectrum antibiotic use. Current guideline recommendations on the timing and duration of antibiotic therapy are based on limited evidence, but will be hard to improve.
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Dinh A, Duran C, Davido B, Lagrange A, Sivadon-Tardy V, Bouchand F, Beauchet A, Gaillard JL, Beaune S, Salomon J, Grenet J. Cost effectiveness of pneumococcal urinary antigen in Emergency Department: a pragmatic real-life study. Intern Emerg Med 2018; 13:69-73. [PMID: 27988829 DOI: 10.1007/s11739-016-1586-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/30/2016] [Indexed: 01/23/2023]
Abstract
Community-acquired pneumonia (CAP) is frequent and can be life-threatening. Streptococcus pneumoniae is the main bacteria involved, and is susceptible to penicillin A. Rapid microbiological diagnosis could then help reduce the antimicrobial spectrum. The pneumococcal urinary antigen (PUA) test is fast and easy to perform, but its impact on antimicrobial prescription and cost-effectiveness in emergency departments (ED) is not well known. We performed a pragmatic real life retrospective study in an adult ED to assess its usefulness: proportion of positive results, impact on antimicrobial prescriptions and cost-effectiveness. Over 3 years (from January 1st 2012 to December 31st 2014), 979 PUA tests were reutilized in our ED among 1224 patients who consulted for CAP; 51 (5.2%) were positive. Among them, 10 led to a modification of the antimicrobial treatment, but only 7 (14.3%) were in accordance with the results. The total cost of a PUA test is 27€. As only 7 PUA tests led to appropriate antimicrobial modification, we deemed that 972 had no impact, and the potential cost savings, if the test had not been used, would have been 26,244 € (972 × 27) during 3 years, that is 8748 € per year. Thus, it seems that the PUA test should not be generally used in the ED considering its low rate of positivity and the difficulties for physicians to adapt antibiotic treatment accordingly. This attitude change in utilization would lead to substantial cost savings.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
| | - Clara Duran
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Aurore Lagrange
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Valérie Sivadon-Tardy
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Frédérique Bouchand
- Pharmacy Department, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Alain Beauchet
- IT Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Sébastien Beaune
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jérôme Salomon
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Julie Grenet
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
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