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[Urinary pneumococcal or Legionella antigen detection tests and low-spectrum antibiotic therapy for community-acquired pneumonia].
Med Mal Infect. 2010 Jun; 40(6):347-51.MM

Abstract

We performed urinary antigen tests for pneumococcus and Legionella for patients with community-acquired pneumonia (CAP), to prescribe a documented antibiotic therapy. We report the efficiency of low-spectrum antibiotic treatment, illustrating the inappropriateness of bacteriological respiratory sampling.

PATIENTS AND METHODS

Patients with CAP were enrolled from three different units; the pneumonia severity index was used to assess the disease. Respiratory samples were also listed. Low-spectrum antibiotic therapy was amoxicillin for pneumococcal infection, and macrolides or non-anti-pneumococcal fluoroquinolone for legionellosis.

RESULTS

Six hundred and seventy-five CAP were diagnosed during the study period,, 150 with positive urinary antigen tests (23%), among which 108 pneumococcal infections (73%), 40 legionellosis (26%), and two mixed infections. The pneumonia severity index was 106+/-38. Amoxicillin was prescribed in 108 cases, fluoroquinolone in 24 cases, macrolide in 18 cases. The outcome was favourable for 138 patients (92%). Eighty three respiratory samples allowed identification of a bacterium for 58 patients (39%), among which 24 strains were not in the antibiotic spectrum: Haemophilus influenzae and Pseudmomonas aeruginosa in six cases, Staphylococcus aureus in five cases, Klebsiella pneumoniae in two cases, and another Gram negative bacillus in five cases. These strains were resistant in vitro to the prescribed treatment in 19/24 cases (79%). One out of 12 patients who died had a respiratory sample positive for Enterobacter spp strain resistant to the ongoing antibiotic treatment.

CONCLUSION

The low-spectrum antibiotic therapy based on urinary antigen tests is efficient, and demonstrates respiratory tract colonisation with bacteriological strains usually considered as pathogenic.

Authors+Show Affiliations

Infectiologie, CHU de Nice, Nice, France. roger.pm@chu-nice.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

fre

PubMed ID

20172672

Citation

Roger, P-M, et al. "[Urinary Pneumococcal or Legionella Antigen Detection Tests and Low-spectrum Antibiotic Therapy for Community-acquired Pneumonia]." Medecine Et Maladies Infectieuses, vol. 40, no. 6, 2010, pp. 347-51.
Roger PM, Risso K, Hyvernat H, et al. [Urinary pneumococcal or Legionella antigen detection tests and low-spectrum antibiotic therapy for community-acquired pneumonia]. Med Mal Infect. 2010;40(6):347-51.
Roger, P. M., Risso, K., Hyvernat, H., Landraud, L., Vassallo, M., Dellamonica, J., de Salvador, F., Cua, E., & Bernardin, G. (2010). [Urinary pneumococcal or Legionella antigen detection tests and low-spectrum antibiotic therapy for community-acquired pneumonia]. Medecine Et Maladies Infectieuses, 40(6), 347-51. https://doi.org/10.1016/j.medmal.2010.01.005
Roger PM, et al. [Urinary Pneumococcal or Legionella Antigen Detection Tests and Low-spectrum Antibiotic Therapy for Community-acquired Pneumonia]. Med Mal Infect. 2010;40(6):347-51. PubMed PMID: 20172672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Urinary pneumococcal or Legionella antigen detection tests and low-spectrum antibiotic therapy for community-acquired pneumonia]. AU - Roger,P-M, AU - Risso,K, AU - Hyvernat,H, AU - Landraud,L, AU - Vassallo,M, AU - Dellamonica,J, AU - de Salvador,F, AU - Cua,E, AU - Bernardin,G, Y1 - 2010/02/20/ PY - 2009/07/25/received PY - 2009/12/01/revised PY - 2010/01/06/accepted PY - 2010/2/23/entrez PY - 2010/2/23/pubmed PY - 2010/11/17/medline SP - 347 EP - 51 JF - Medecine et maladies infectieuses JO - Med Mal Infect VL - 40 IS - 6 N2 - UNLABELLED: We performed urinary antigen tests for pneumococcus and Legionella for patients with community-acquired pneumonia (CAP), to prescribe a documented antibiotic therapy. We report the efficiency of low-spectrum antibiotic treatment, illustrating the inappropriateness of bacteriological respiratory sampling. PATIENTS AND METHODS: Patients with CAP were enrolled from three different units; the pneumonia severity index was used to assess the disease. Respiratory samples were also listed. Low-spectrum antibiotic therapy was amoxicillin for pneumococcal infection, and macrolides or non-anti-pneumococcal fluoroquinolone for legionellosis. RESULTS: Six hundred and seventy-five CAP were diagnosed during the study period,, 150 with positive urinary antigen tests (23%), among which 108 pneumococcal infections (73%), 40 legionellosis (26%), and two mixed infections. The pneumonia severity index was 106+/-38. Amoxicillin was prescribed in 108 cases, fluoroquinolone in 24 cases, macrolide in 18 cases. The outcome was favourable for 138 patients (92%). Eighty three respiratory samples allowed identification of a bacterium for 58 patients (39%), among which 24 strains were not in the antibiotic spectrum: Haemophilus influenzae and Pseudmomonas aeruginosa in six cases, Staphylococcus aureus in five cases, Klebsiella pneumoniae in two cases, and another Gram negative bacillus in five cases. These strains were resistant in vitro to the prescribed treatment in 19/24 cases (79%). One out of 12 patients who died had a respiratory sample positive for Enterobacter spp strain resistant to the ongoing antibiotic treatment. CONCLUSION: The low-spectrum antibiotic therapy based on urinary antigen tests is efficient, and demonstrates respiratory tract colonisation with bacteriological strains usually considered as pathogenic. SN - 1769-6690 UR - https://www.unboundmedicine.com/medline/citation/20172672/[Urinary_pneumococcal_or_Legionella_antigen_detection_tests_and_low_spectrum_antibiotic_therapy_for_community_acquired_pneumonia]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0399-077X(10)00007-7 DB - PRIME DP - Unbound Medicine ER -