Only 1 in 6 pneumonia patients undergoes urinary antigen testing

  • Schimmel JJ & al.
  • Clin Infect Dis
  • 07.10.2019

  • von Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • Retrospective cohort study assessing national UAT recommendations adherence trends, associated antimicrobial deescalation, outcomes.
  • Funding: Agency for Healthcare Research and Quality.

Limitations

  • Unmeasured confounding.
  • Possible underestimated UAT usage.
  • Limited UAT access during study period.