Urinary antigen testing linked to earlier antibiotic de-escalation in CAP
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Among patients with community-acquired pneumonia, receipt of a positive pneumococcal urinary antigen test was associated with earlier de-escalation of antimicrobials compared with patients who received a negative test, according to a study.
Pneumococcal urinary antigen (PUAT) testing is noninvasive and can help diagnose community-acquired pneumonia (CAP) in as little as 15 minutes with high sensitivity and specificity, according to Adam Greenfield, PharmD, a pharmacist at VCU Health.
In 2016, the antimicrobial stewardship program at NYU Langone Health in New York City collaborated with other specialties to develop CAP guidelines and a CAP admission order set that standardized the use of PUAT, Greenfield told Healio.
“We sought to evaluate the impact of PUAT in patients admitted with CAP following universal use of this test,” said Greenfield, who was an infectious disease pharmacy resident a NYU Langone during the study.
Greenfield and colleagues performed a retrospective study of hospitalized adults with a PUAT between January and December 2019. They compared the incidence and timing of de-escalation in PUAT-positive and PUAT-negative groups and then described patient outcomes.
In total, 910 patients were included in the study, of whom 121 (13.3%) were PUAT positive. The researchers found no difference in baseline characteristics — including severity of illness — between PUAT groups.
They found that initial de-escalation occurred in 82.9% and 81.2% of PUAT-positive and PUAT-negative patients, respectively (P = .749). Within 24 hours of PUAT, the discontinuation of atypical coverage was more common among patients in the PUAT-positive than PUAT-negative group (61.3% vs. 47.2%, P = .026) without a difference in the discontinuation of anti-MRSA agents (53.3% vs 47.9%, P = .610) or antipseudomonal de-escalation (57.1% vs. 55.9%, P = .895).
Additionally, an unadjusted analysis demonstrated that among patients in the PUAT-positive group, there was a shorter length of stay for patients who were de-escalated compared with those who were not de-escalated or required escalation (P = .0005) without difference in the incidence of Clostridioides difficile, in-hospital mortality or 30-day infection-related readmission, Greenfield and colleagues wrote.
“In order to have the greatest impact, testing should be considered on all patients admitted with a diagnosis of CAP and coordinated efforts should be made with microbiology personnel to ensure appropriate workflows are established for timely PUAT results,” Greenfield said.
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