Pneumococcal urinary antigen testing in US hospitals: A missed opportunity for antimicrobial stewardship
Author Department
Infectious Diseases; Healthcare Quality; Medicine
Document Type
Article, Peer-reviewed
Publication Date
10-2019
Abstract
BACKGROUND:
The Infectious Disease Society of America recommends pneumococcal urinary antigen testing (UAT) when identifying pneumococcal infection would allow for antibiotic de-escalation. However, the frequencies of UAT and subsequent antibiotic de-escalation are unknown.
METHODS:
We conducted a retrospective cohort study of adult patients admitted with community-acquired or healthcare-associated pneumonia to 170 US hospitals in the Premier database from 2010-2015, to describe variation in UAT use, associations of UAT results with antibiotic de-escalation, and associations of de-escalation with outcomes.
RESULTS:
Among 159,894 eligible admissions, 24,757 (15.5%) included UAT performed (18.4% of ICU and 15.3% of non-ICU patients). Among hospitals with ≥100 eligible patients, UAT testing proportions ranged from 0%-69%. Compared to patients with negative UAT, 7.2% with positive UAT more often had a positive S. pneumoniae culture (25.4% vs. 1.9%, p<0.001) and less often had resistant bacteria (5.2% vs. 6.8%, p<0.05). Of patients initially treated with broad-spectrum antibiotics, most were still receiving broad-spectrum therapy 3 days later, but UAT-positive patients more often had coverage narrowed (38.4% vs. 17.0% UAT-negative and 14.6% untested patients, p<0.001). Hospital rate of UAT was strongly correlated with de-escalation following a positive test. Only 3 patients de-escalated after positive UAT were subsequently admitted to ICU.
CONCLUSIONS AND RELEVANCE:
UAT is not ordered routinely in pneumonia, even in ICU. A positive UAT was associated with less frequent resistant organisms, but usually did not lead to antibiotic de-escalation. Increasing UAT and narrowing therapy after a positive UAT are opportunities for improved antimicrobial stewardship.
Recommended Citation
Schimmel JJ, Haessler S, Imrey P, Lindenauer PK, Richter SS, Yu PC, Rothberg MB. Pneumococcal urinary antigen testing in US hospitals: A missed opportunity for antimicrobial stewardship. Clin Infect Dis. 2019 Oct 7.
PMID
31587039