Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia
- 1Internal Medicine Service, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Institut de Recerca Biomèdia de Lleida (IRBLLEIDA), Lleida, Ciber de Enfermedades Respiratorias, Spain
- 2Pharmacy Services, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Institut de Recerca Biomèdia de Lleida (IRBLLEIDA), Lleida, Spain
- Correspondence to Professor Miquel Falguera, Service of Internal Medicine, Hospital Universitari Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain;
- Received 25 April 2009
- Accepted 3 August 2009
- Published Online First 23 August 2009
Background Recommendations for diagnostic testing in hospitalised patients with community-acquired pneumonia remain controversial. The aim of the present study was to evaluate the impact of a therapeutic strategy based on the microbiological results provided by urinary antigen tests for Streptococcus pneumoniae and Legionella pneumophila.
Methods For a 2-year period, hospitalised patients with community-acquired pneumonia were randomly assigned to receive either empirical treatment, according to international guidelines, or targeted treatment, on the basis of the results from antigen tests. Outcome parameters, monetary costs and antibiotic exposure levels were compared.
Results Out of 194 enrolled patients, 177 were available for randomisation; 89 were assigned to empirical treatment and 88 were assigned to targeted treatment. Targeted treatment was associated with a slightly higher overall cost (€1657.00 vs €1617.20, p=0.28), reduction in the incidence of adverse events (9% vs 18%, p=0.12) and lower exposure to broad-spectrum antimicrobials (154.4 vs 183.3 defined daily doses per 100 patient days). No statistically significant differences in other outcome parameters were observed. Oral antibiotic treatment was started according to the results of antigen tests in 25 patients assigned to targeted treatment; these patients showed a statistically significant higher risk of clinical relapse as compared with the remaining population (12% vs 3%, p=0.04).
Conclusions The routine implementation of urine antigen detection tests does not carry substantial outcome-related or economic benefits to hospitalised patients with community-acquired pneumonia. Narrowing the antibiotic treatment according to the urine antigen results may in fact be associated with a higher risk of clinical relapse.
- Community-acquired pneumonia
- urinary antigen detection tests
- diagnostic methods
- therapeutic strategy
See Editorial, p93
Linked articles 124156.
Funding Ciber de Enfermedades Respiratorias (Ciberes 06/06/0028) Spain.
Competing interests None.
Ethics approval This study was conducted with the approval of the Scientific and ethic committees of Hospital Universitari Arnau de Vilanova, Lleida, Spain.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.