title: Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients.
abstract: We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
authors.forename: A
authors.initials: A
authors.lastname: Putot
authors.affiliation: Department of Microbiology, University Hospital, Dijon, France.
authors.forename: J
authors.initials: J
authors.lastname: Tetu
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
authors.forename: S
authors.initials: S
authors.lastname: Perrin
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
authors.forename: H
authors.initials: H
authors.lastname: Bailly
authors.affiliation: Department of Infectious Diseases, University Hospital, Dijon, France.
authors.forename: L
authors.initials: L
authors.lastname: Piroth
authors.affiliation: Department of Internal Medicine 2, University Hospital, Dijon, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Besancenot
authors.affiliation: Department of Internal Medicine 1, University Hospital, Dijon, France.
authors.forename: B
authors.initials: B
authors.lastname: Bonnotte
authors.affiliation: Department of Infectious Diseases, University Hospital, Dijon, France.
authors.forename: P
authors.initials: P
authors.lastname: Chavanet
authors.affiliation: Department of Biostatistics and Medical Computing, University Hospital, Dijon, France.
authors.forename: P
authors.initials: P
authors.lastname: d'Athis
authors.affiliation: Medical Intensive Care Unit, University Hospital, Dijon, France.
authors.forename: P-E
authors.initials: PE
authors.lastname: Charles
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.
authors.forename: H
authors.initials: H
authors.lastname: Sordet-Guépet
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France. patrick.manckoundia@chu-dijon.fr.|Inserm/U1093 Motricity-Plasticity, University of Burgundy and Franche Comté, Dijon, France. patrick.manckoundia@chu-dijon.fr.
authors.forename: P
authors.initials: P
authors.lastname: Manckoundia
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents