Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia.
BACKGROUND
Recommendations for diagnostic testing in hospitalised patients with community-acquired pneumonia remain controversial. The aim of the present study was to evaluate the impact of a therapeutic strategy based on the microbiological results provided by urinary antigen tests for Streptococcus pneumoniae and Legionella pneumophila.


METHODS
For a 2-year period, hospitalised patients with community-acquired pneumonia were randomly assigned to receive either empirical treatment, according to international guidelines, or targeted treatment, on the basis of the results from antigen tests. Outcome parameters, monetary costs and antibiotic exposure levels were compared.


RESULTS
Out of 194 enrolled patients, 177 were available for randomisation; 89 were assigned to empirical treatment and 88 were assigned to targeted treatment. Targeted treatment was associated with a slightly higher overall cost (euro 1657.00 vs euro 1617.20, p=0.28), reduction in the incidence of adverse events (9% vs 18%, p=0.12) and lower exposure to broad-spectrum antimicrobials (154.4 vs 183.3 defined daily doses per 100 patient days). No statistically significant differences in other outcome parameters were observed. Oral antibiotic treatment was started according to the results of antigen tests in 25 patients assigned to targeted treatment; these patients showed a statistically significant higher risk of clinical relapse as compared with the remaining population (12% vs 3%, p=0.04).


CONCLUSIONS
The routine implementation of urine antigen detection tests does not carry substantial outcome-related or economic benefits to hospitalised patients with community-acquired pneumonia. Narrowing the antibiotic treatment according to the urine antigen results may in fact be associated with a higher risk of clinical relapse.
Falguera
M
M
Service of Internal Medicine, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Institut de Recerca Biomèdia de Lleida (IRBLLEIDA), Lleida, Spain. mfalguera@comll.cat
Ruiz-González
A
A
Schoenenberger
J A
JA
Touzón
C
C
Gázquez
I
I
Galindo
C
C
Porcel
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000652:urine*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007875:Legionella / Q000276:immunology; D007877:Legionnaires' Disease / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000276:immunology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial