Determinants of empirical antipseudomonal antibiotic prescription for adults with pneumonia in the emergency department
Angrill Sellés, Núria (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Gallego, Miguel (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Font, Juli (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Vallés, Jordi (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Morón, Anisi (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Monsó, Eduard (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rello, Jordi (Université Montpellier-Nîmes. Research Department, CHU Nîmes)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Antipseudomonal antibiotics should be restricted to patients at risk of Pseudomonas aeruginosa infection. However, the indications in different guidelines on community-acquired pneumonia (CAP) are discordant. Our objectives were to assess the prevalence of antipseudomonal antibiotic prescriptions and to identify determinants of empirical antibiotic choices in the emergency department. Observational, retrospective, one-year cohort study in hospitalized adults with pneumonia. Antibiotic choices and clinical and demographic data were recorded on a standardized form. Antibiotics with antipseudomonal activity were classified into two groups: a) β-lactam antipseudomonals (β-APS), including carbapenems, piperacillin / tazobactam or cefepime (in monotherapy or combination) and b) monotherapy with antipseudomonal quinolones. Data were recorded from 549 adults with pneumonia, with Pseudomonas aeruginosa being isolated in only nine (1. 6%). Most (85%) prescriptions were compliant with SEPAR guidelines and 207 (37%) patients received antibiotics with antipseudomonal activity (14% β-APS and 23% levofloxacin). The use of β-APS was independently associated with ICU admission (OR 8. 16 95% CI 3. 69-18. 06) and prior hospitalization (OR 6. 76 95% CI 3. 02-15. 15), while levofloxacin was associated with negative pneumococcal urine antigen tests (OR 3. 41 95% CI 1. 70-6. 85) but negatively associated with ICU admission (OR 0. 26 95% CI 0. 08-0. 86). None of these factors were associated with P aeruginosa episodes. In univariate analysis, prior P aeruginosa infection/colonization (2/9 vs 6/372, p = 0. 013), severe COPD (3/9 vs 26/372, p = 0. 024), multilobar involvement (7/9 vs 119/372, p = 0. 007) and prior antibiotic (6/9 vs 109/372, p = 0. 025) were significantly associated with P aeruginosa episodes. Antipseudomonal prescriptions were common, in spite of the very low incidence of Pseudomonas aeruginosa. The rationale for prescription was influenced by both severity-of-illness and pneumococcal urine antigen test (levofloxacin) and prior hospitalization and ICU admission (β-APS). However, these factors were not associated with P aeruginosa episodes. Only prior P aeruginosa infection/colonization and severe COPD seem to be reliable indicators in clinical practice.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Pneumonia ; P aeruginosa ; Antipseudomonal antibiotics ; Levofloxacin ; Guidelines
Publicat a:	BMC Pulmonary Medicine, Vol. 20 (april 2020) , ISSN 1471-2466

DOI: 10.1186/s12890-020-1115-0
PMID: 32245452

9 p, 688.1 KB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d’Investigació i Innovació Parc Taulí (I3PT)
Articles > Articles de recerca
Articles > Articles publicats