title: Value of rapid aetiological diagnosis in optimization of antimicrobial treatment in bacterial community acquired pneumonia.
abstract: In 80 adult patients with community acquired pneumonia (CAP) conventional microbiological methods, polymerase chain reaction (PCR) and serum C-reactive protein (CRP) levels were performed and the appropriateness of the empirical antimicrobial treatment was evaluated according to bacterial pathogen detected. The aetiology was determined in 42 (52.5%) patients, with Streptococcus pneumoniae as the most common pathogen. PCR applied to bronchoalveolar lavage (BAL) provided 2 and PCR on sputum samples 1 additional aetiological diagnosis of CAP The mean CRP values in the S. pneumoniae group were not significantly higher than in the group with other aetiological diagnoses (166.89 mg/L vs. 160.11 mg/L, p = 0.457). In 23.8% (10/42) of patients with determined aetiology, the empirical antimicrobial treatment was inappropriate. PCR tests need further investigation, particularly those for the atypical pathogens, as they are predominant in inappropriately treated patients. Our results do not support the use of CRP as a rapid test to guide the antimicrobial treatment in patients with CAP.
authors.affiliation: University of Zagreb, Zagreb University Hospital Center, Department of Clinical and Molecular Microbiology, Zagreb, Croatia. ivanamarekovic@yahoo.com
authors.forename: Ivana
authors.initials: I
authors.lastname: Mareković
authors.forename: Vanda
authors.initials: V
authors.lastname: Plecko
authors.forename: Zagorka
authors.initials: Z
authors.lastname: Boras
authors.forename: Ladislav
authors.initials: L
authors.lastname: Pavlović
authors.forename: Ana
authors.initials: A
authors.lastname: Budimir
authors.forename: Zrinka
authors.initials: Z
authors.lastname: Bosnjak
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Puretić
authors.forename: Lidija
authors.initials: L
authors.lastname: Zele-Starcević
authors.forename: Smilja
authors.initials: S
authors.lastname: Kalenić
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000379:methods; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein