title: Severe community-acquired pneumonia and positive urinary antigen test for S. pneumoniae: amoxicillin is associated with a favourable outcome.
abstract: Positive urinary antigen tests (UAT) for pneumococcal infection in community-acquired pneumonia (CAP) may lead to targeted antibiotic therapy. We report an audit aimed at defining the link between mortality and targeted therapy. We conducted a retrospective multicentre audit of patients with severe CAP for whom a UAT was positive for S. pneumoniae. Patients admitted from January 2010 to December 2013 to 8 medical centres (from A to H) were included. Co-morbidities were defined by the specific treatment administered before hospital care, or if the diagnosis was newly established during the hospital stay. We used the Pneumonia Severity Index (PSI) to assess disease severity. Only patients with PSI > 90 were included. Antibiotic treatments and the PSI were extracted from patients' charts. Amoxicillin had to be prescribed as a targeted antibiotic treatment or at the time of antibiotic reassessment. A total of 389 patients were included. The mean (±STD) PSI score was 128 ± 29; 38.9% of the patients had a class 5 PSI score. Intensive care was required for 36.6% of the patients. Amoxicillin was initially prescribed in 47 cases (12.1%) and in 34 cases after reassessment (8.7%). In logistic regression analysis, we found three parameters associated with mortality: being hospitalised in institution D, class 5 PSI score, and metastatic cancer. In contrast, three antibiotic regimens were protective factors, including targeted therapy: OR = 0.09, p < 0.001. In the context of severe CAP with positive UAT for S. pneumoniae, targeted therapy was associated with a reduction in mortality.
authors.affiliation: Microbiologie, Centre Hospitalier d'Antibes, Antibes, France.
authors.forename: V
authors.initials: V
authors.lastname: Blanc
authors.affiliation: Médecine Interne, Centre Hospitalier de Draguignan, Draguignan, France.
authors.forename: A
authors.initials: A
authors.lastname: Mothes
authors.affiliation: Microbiologie, Centre Hospitalier de Draguignan, Draguignan, France.
authors.forename: A
authors.initials: A
authors.lastname: Smetz
authors.affiliation: Pneumologie, Centre Hospitalier d'Antibes, Antibes, France.
authors.forename: I
authors.initials: I
authors.lastname: Timontin
authors.affiliation: Réanimation Polyvalente, Clinique Les Fleurs, Ollioules, France.
authors.forename: M D
authors.initials: MD
authors.lastname: Guardia
authors.affiliation: SELAS Laboratoire Billiemaz, Toulon, France.
authors.forename: A
authors.initials: A
authors.lastname: Billiemaz
authors.affiliation: Réanimation Médicale, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Dellamonica
authors.affiliation: Médecine Interne, Centre Hospitalier de Cannes, Cannes, France.
authors.forename: M
authors.initials: M
authors.lastname: Vassallo
authors.affiliation: Microbiologie, Centre Hospitalier de Cannes, Cannes, France.
authors.forename: D
authors.initials: D
authors.lastname: Néri
authors.affiliation: Infectiologie, Centre Hospitalier de Hyères, Hyères, France.
authors.forename: S
authors.initials: S
authors.lastname: Chadapaud
authors.affiliation: Microbiologie, Centre Hospitalier de Hyères, Hyères, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Toyer
authors.affiliation: Dermato-Infectiologie, Centre Hospitalier de Fréjus-St-Raphael, Saint-Raphaël, France.
authors.forename: P
authors.initials: P
authors.lastname: Del Guidice
authors.affiliation: Microbiologie, Centre Hospitalier de Fréjus-St-Raphael, Saint-Raphaël, France.
authors.forename: A
authors.initials: A
authors.lastname: Fribourg
authors.affiliation: Microbiologie, Centre Hospitalier de Grasse, Grasse, France.
authors.forename: S
authors.initials: S
authors.lastname: Léotard
authors.affiliation: Pneumologie, Centre Hospitalier de Grasse, Grasse, France.
authors.forename: I
authors.initials: I
authors.lastname: Nicolle
authors.affiliation: Infectiologie, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Hôpital de l'Archet 1, BP 3079, 06202, Nice, France. roger.pm@chu-nice.fr.
authors.forename: P-M
authors.initials: PM
authors.lastname: Roger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000652:urine*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D000658:Amoxicillin