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Pneumococcal urinar...
Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia : A register-based cohort study
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- Athlin, Simon, 1971- (author)
- Örebro universitet,Institutionen för medicinska vetenskaper,Department of Infectious Diseases
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- Magnuson, Anders (author)
- School of Medical Sciences, Örebro University, Örebro, Sweden,Clinical Epidemiology and Biostatistics
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- Spindler, Carl (author)
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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- Hedlund, Jonas (author)
- Karolinska Institutet
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- Strålin, Kristoffer (author)
- Karolinska Institutet
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- Nauclér, Pontus (author)
- Karolinska Institutet
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(creator_code:org_t)
- Elsevier, 2022
- 2022
- English.
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In: Journal of Infection. - : Elsevier. - 0163-4453 .- 1532-2742. ; 85:2, s. 167-173
- Related links:
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
Subject headings
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- OBJECTIVES: To evaluate the effect of pneumococcal urinary antigen test (UAT) usage on broad-spectrum antibiotic treatment in community-acquired pneumonia (CAP).METHODS: Patients admitted to 32 Swedish hospitals between 2011 and 2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM).RESULTS: UAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94-1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06-2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25-0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16-0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69-3.98) and 3-4 (OR 3.69, 95% CI 1.55-8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3-4 patients (OR 3.49, 95% CI 1.02-12.0).CONCLUSIONS: Performing UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
Keyword
- Antibiotic stewardship
- Broad-spectrum antibiotics
- Community-acquired pneumonia
- Pneumococcus
- Streptococcus pneumoniae
- Urinary antigen test
Publication and Content Type
- ref (subject category)
- art (subject category)
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