Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients.
Fiche publication
Date publication
mars 2016
Journal
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BONNOTTE Bernard
Tous les auteurs :
Putot A, Tetu J, Perrin S, Bailly H, Piroth L, Besancenot JF, Bonnotte B, Chavanet P, d'Athis P, Charles PE, Sordet-Guépet H, Manckoundia P
Lien Pubmed
Résumé
We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.
Mots clés
Age Factors, Aged, Aged, 80 and over, Anti-Infective Agents, therapeutic use, Community-Acquired Infections, diagnosis, Cross Infection, diagnosis, Disease Management, Female, Hospital Mortality, Hospitalization, Hospitals, Humans, Male, Nursing Homes, Pneumonia, diagnosis, Retrospective Studies, Severity of Illness Index, Treatment Outcome
Référence
Eur. J. Clin. Microbiol. Infect. Dis.. 2016 Mar;35(3):489-95