title: Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy.
abstract: BACKGROUND
  The use of rapid microbiological tests is supported by antimicrobial stewardship policies. Targeted antibiotic therapy (TAT) for community-acquired pneumonia (CAP) with positive urinary antigen test (UAT) has been associated with a favorable impact on outcome. We aimed to determine the factors associated with TAT prescription.
  
  
  METHODS
  We conducted a retrospective multicenter study including all patients presenting with CAP and positive UAT for Streptococcus pneumoniae or Legionella pneumophila from January 2010 to December 2013. Patients presenting with aspiration pneumonia, coinfection, and neutropenia were excluded. CAP severity was assessed using the Pneumonia Severity Index (PSI). TAT was defined as the administration of amoxicillin for pneumococcal infection and either macrolides or fluoroquinolones (inactive against S. pneumoniae) for Legionella infection.
  
  
  RESULTS
  A total of 861 patients were included, including 687 pneumococcal infections and 174 legionellosis from eight facilities and 37 medical departments. TAT was prescribed to 273 patients (32%). Four factors were found independently associated with a lower rate of TAT: a PSI score≥4 (OR 0.37), Hospital A (OR 0.41), hospitalization in the intensive care unit (OR 0.44), and cardiac comorbidities (OR 0.60). Four other factors were associated with a high rate of TAT: positive blood culture for S. pneumoniae (OR 2.32), Hospitals B (OR 2.34), E (OR 2.68), and H (OR 9.32).
  
  
  CONCLUSIONS
  TAT in CAP with positive UAT was related to the hospitals as well as to patient characteristics.
authors.affiliation: Service d'infectiologie, centre hospitalier de Draguignan, 83300 Draguignan, France.
authors.forename: A
authors.initials: A
authors.lastname: Mothes
authors.affiliation: Service de microbiologie, centre hospitalier de Grasse, 06130 Grasse, France.
authors.forename: S
authors.initials: S
authors.lastname: Léotard
authors.affiliation: Service de pneumologie, centre hospitalier de Grasse, 06130 Grasse, France.
authors.forename: I
authors.initials: I
authors.lastname: Nicolle
authors.affiliation: Service de microbiologie, centre hospitalier de Draguignan, 83300 Draguignan, France.
authors.forename: A
authors.initials: A
authors.lastname: Smets
authors.affiliation: Service d'infectiologie, hôpital de l'Archet 1, centre hospitalier universitaire de Nice, BP 3079, 06202 Nice, France.
authors.forename: D
authors.initials: D
authors.lastname: Chirio
authors.affiliation: Service de pneumologie, centre hospitalier d'Antibes, 06600 Antibes, France.
authors.forename: C
authors.initials: C
authors.lastname: Rotomondo
authors.affiliation: Service de réanimation polyvalente, centre hospitalier d'Antibes, 06600 Antibes, France.
authors.forename: F
authors.initials: F
authors.lastname: Tiger
authors.affiliation: Service d'infectiologie-dermatologie, centre hospitalier de Fréjus-St-Raphaël, 83600 Fréjus, France.
authors.forename: P
authors.initials: P
authors.lastname: Del Giudice
authors.affiliation: Service de pneumologie, centre hospitalier de Cannes, 06400 Cannes, France.
authors.forename: C
authors.initials: C
authors.lastname: Perrin
authors.affiliation: Service de microbiologie, centre hospitalier de Cannes, 06400 Cannes, France.
authors.forename: D
authors.initials: D
authors.lastname: Néri
authors.affiliation: Service d'infectiologie, centre hospitalier de Hyères, 83400 Hyères, France.
authors.forename: C
authors.initials: C
authors.lastname: Foucault
authors.affiliation: Service de réanimation polyvalente, clinique Les Fleurs, 83190 Ollioules, France.
authors.forename: M
authors.initials: M
authors.lastname: Della Guardia
authors.affiliation: Service de réanimation médicale, centre hospitalier universitaire de Nice, 06202 Nice, France.
authors.forename: H
authors.initials: H
authors.lastname: Hyvernat
authors.affiliation: Service d'infectiologie, hôpital de l'Archet 1, centre hospitalier universitaire de Nice, BP 3079, 06202 Nice, France. Electronic address: roger.pm@chu-nice.fr.
authors.forename: P-M
authors.initials: PM
authors.lastname: Roger
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000652:urine*; D000073602:Antimicrobial Stewardship; D016470:Bacteremia / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000652:urine; D015897:Comorbidity; D003955:Diagnostic Tests, Routine; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D006748:Hospital Departments; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D016952:Legionella pneumophila / Q000276:immunology*; D007877:Legionnaires' Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000652:urine; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000652:urine; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000276:immunology*
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial
keywords: Antigènes urinaires; Antimicrobial stewardship; Bon usage des antibiotiques; Community-acquired pneumonia; Legionella; Pneumocoque; Pneumonie aiguë communautaire; S. pneumoniae; Urinary antigen test