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. 2018 Oct 8;4(4):00096-2018.
doi: 10.1183/23120541.00096-2018. eCollection 2018 Oct.

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

Manuela Carugati  1   2   3 , Stefano Aliberti  4   5 , Luis Felipe Reyes  6   7 , Ricardo Franco Sadud  8 , Muhammad Irfan  9 , Cristina Prat  10 , Nilam J Soni  11 , Paola Faverio  12 , Andrea Gori  3   4 , Francesco Blasi  4   5 , Marcos I Restrepo  11
Affiliations

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

Manuela Carugati et al. ERJ Open Res. .

Abstract

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations.

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Conflict of interest statement

Conflict of interest: M. Carugati has nothing to disclose. Conflict of interest: S. Aliberti reports grants and personal fees from Bayer Healthcare, Aradigm Corporation, Grifols, Chiesi and Insmed, and personal fees from AstraZeneca, Basilea, Zambon, Novartis, Raptor, Actavis UK Ltd and Horizon, all outside the submitted work. Conflict of interest: L.F. Reyes has nothing to disclose. Conflict of interest: R. Franco Sadud has nothing to disclose. Conflict of interest: M. Irfan has nothing to disclose. Conflict of interest: C. Prat has nothing to disclose. Conflict of interest: N.J. Soni has nothing to disclose. Conflict of interest: P. Faverio has nothing to disclose. Conflict of interest: A. Gori reports receipt of grants/research support from Abbvie, Astellas, BMS, Boehringer, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, ViiV and ANLAIDS Sezione Lombarda, receipt of honoraria or consultation fees from BMS, Gilead, Janssen, MSD, Novartis and ViiV, participation in a company sponsored speakers’ bureau from Gilead, and travel grants/support from BMS, Gilead, Janssen and ViiV. Conflict of interest: F. Blasi reports personal fees from AstraZeneca, Guidotti Malesci, GSK and Novartis, and grants and personal fees from Bayer and Chiesi, Grifols, Insmed, Menarini, Pfizer, Teva and Zambon, all outside the submitted work. Conflict of interest: M.I. Restrepo has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Discordance of diagnostic testing with the a) 2007 Infectious Diseases Society of America/American Thoracic Society (ATS) guidelines and b) 2011 European Respiratory Society (ERS) guidelines for community-acquired pneumonia by geographic area. Over: over-testing; under: under-testing; over/under: over-testing and under-testing.
See this image and copyright information in PMC

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