- Despite guidelines, utilization of pneumococcal urinary antigen testing (UAT) is low and highly variable, averaging ~16%.
Why this matters
- UAT specificity is about 97%; increasing UAT utilization improves deescalation of antimicrobials and promotes antimicrobial stewardship.
- 159,894 patients included; 16.2% (25,932) received UAT.
- UAT utilization rates ranged from 0% to 69% across hospitals; 1 in 3 reported no UAT.
- 7.2% of tests were positive.
- 8.9% vs 6.4% of positive tests occurred inside vs outside ICUs, respectively.
- 25.4% vs 1.9% of patients with positive vs negative UAT were likely to have Staphylococcus pneumoniae isolated from blood or sputum (P<.001 less likely to grow other organisms vs respectively>
- Median duration of antibiotics for positive, negative, no UAT patients was 3, 4, 5 days, respectively (P<.001>
- In-hospital mortality rates: 4.4% in UAT patients deescalated by day 3 vs negative UAT (aOR, 0.81; 95% CI, 0.43-1.52), no UAT (aOR, 0.69; 95% CI, 0.38-1.24).
- Retrospective cohort study assessing national UAT recommendations adherence trends, associated antimicrobial deescalation, outcomes.
- Funding: Agency for Healthcare Research and Quality.
- Unmeasured confounding.
- Possible underestimated UAT usage.
- Limited UAT access during study period.