Impact of a positive Binax NOW Streptococcus pneumoniae urinary antigen test on antibiotics policy
Abstract number: P1290
Matta M., Buu Hoï A., Varon E., Gutmann L., Mainardi J.L.
Objectives: To evaluate the impact of a positive Binax NOW Streptococcus pneumoniae urinary antigen test (UAT) on the use of a targeted anti-pneumococcal therapy for the treatment of community-acquired pneumonia.
Methods: From April 2004 to December 2005, we retrospectively analysed 96 consecutive patients admitted to the emergency room for a presumptive diagnosis of pneumonia with a positive UAT. Patients with associated meningitis were excluded. We reviewed the antimicrobial therapy used before and after the positive result of the UAT, and particularly the proportion of patients under amoxicillin.
Results: Among the 96 patients, 92 were available for the study. Mean age was 64 years (median age 61 y, range 1899 y) and 49 patients (51%) were male. Eighty nine patients (97%) had a blood or a respiratory tract sample which, in 23 patients (25%), was positive for S. pneumoniae. Prior to the UAT result, 22 patients (24%) had no antibiotics, 11 (12%) received amoxicillin, 25 (27%) amoxicillin-clavulanic acid (AMC) or a third-generation cephalosporin (C3G), and 29 (32%) received an association of b-lactam with a macrolide or a fluoroquinolone. Once the physician was informed of a positive UAT, among the 22 patients not treated initially, 7 received amoxicillin secondarily, 7 had AMC or C3G, and 4 had an association. Overall, the number of patients treated with amoxicillin rose to 38 (41%), those receiving AMC or C3G rose to 30 (33%) whereas patients under an association of antibiotics decreased to 12 (13%). Among the 23 patients who had a positive sample for S. pneumoniae, 12 had an antimicrobial therapy with a broader spectrum than amoxicillin even once the susceptibility to b-lactams was known.
Conclusions: In case of community-acquired pneumonia at the emergency room, physicians often prefer to prescribe a first line antimicrobial therapy with a broader spectrum than amoxicillin. Although a positive UAT resulted in an increased number of patients treated by amoxicillin alone from 12 to 41 percent, it is noteworthy that in almost 60 percent of the cases antibiotic spectrum was not narrowed.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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