Abstract：
To evaluate the effect of pneumococcal urinary antigen test (UAT) usage on broad-spectrum antibiotic treatment in community-acquired pneumonia (CAP).
Patients admitted to 32 Swedish hospitals between 2011 and 2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM).
UAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94-1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06-2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25-0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16-0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69-3.98) and 3-4 (OR 3.69, 95% CI 1.55-8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3-4 patients (OR 3.49, 95% CI 1.02-12.0).
Performing UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.
Patients admitted to 32 Swedish hospitals between 2011 and 2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM).
UAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94-1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06-2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25-0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16-0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69-3.98) and 3-4 (OR 3.69, 95% CI 1.55-8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3-4 patients (OR 3.49, 95% CI 1.02-12.0).
Performing UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.
摘要：
评价肺炎球菌尿抗原检测(UAT)在社区获得性肺炎(CAP)广谱抗生素治疗中的应用效果。
2011年至2014年期间，32家瑞典医院收治的患者被回顾性纳入了瑞典国家CAP质量登记册。使用倾向得分匹配的数据，按CRB-65评分分层，与窄谱β-内酰胺单药治疗(NSBM)相比,我们研究了使用广谱β-内酰胺单药治疗(BSBM)和具有非典型细菌覆盖率的抗生素进行UAT和阳性检测结果的效果.
对4,995/14,590（34.2％）患者进行了UAT，603/4,995（12.1％）的测试结果为阳性。第三天,在CRB-65评分为2分的患者中,进行UAT与BSBM使用减少无关(OR1.07,95%CI0.94~1.23),但与非典型覆盖率增加相关(OR1.47,95%CI1.06~2.02).UAT阳性与BSBM使用减少（OR0.39，95％CI0.25-0.60）和非典型覆盖率降低（OR0.25，95％CI0.16-0.37）相关，主要发生在非重度CAP中。第一天,在CRB-65评分为2（OR2.60，95％CI1.69-3.98）和3-4（OR3.69，95％CI1.55-8.79）的患者中，执行UAT与非典型覆盖率相关，在CRB-65评分为3~4分的患者中,阳性检测降低了BSBM治疗的几率(OR3.49,95%CI1.02~12.0).
进行UAT对减少住院第三天使用BSBM治疗没有总体影响，然而,UAT结果为阳性的非重症患者接受BSBM和非典型覆盖抗生素治疗的可能性较小.
2011年至2014年期间，32家瑞典医院收治的患者被回顾性纳入了瑞典国家CAP质量登记册。使用倾向得分匹配的数据，按CRB-65评分分层，与窄谱β-内酰胺单药治疗(NSBM)相比,我们研究了使用广谱β-内酰胺单药治疗(BSBM)和具有非典型细菌覆盖率的抗生素进行UAT和阳性检测结果的效果.
对4,995/14,590（34.2％）患者进行了UAT，603/4,995（12.1％）的测试结果为阳性。第三天,在CRB-65评分为2分的患者中,进行UAT与BSBM使用减少无关(OR1.07,95%CI0.94~1.23),但与非典型覆盖率增加相关(OR1.47,95%CI1.06~2.02).UAT阳性与BSBM使用减少（OR0.39，95％CI0.25-0.60）和非典型覆盖率降低（OR0.25，95％CI0.16-0.37）相关，主要发生在非重度CAP中。第一天,在CRB-65评分为2（OR2.60，95％CI1.69-3.98）和3-4（OR3.69，95％CI1.55-8.79）的患者中，执行UAT与非典型覆盖率相关，在CRB-65评分为3~4分的患者中,阳性检测降低了BSBM治疗的几率(OR3.49,95%CI1.02~12.0).
进行UAT对减少住院第三天使用BSBM治疗没有总体影响，然而,UAT结果为阳性的非重症患者接受BSBM和非典型覆盖抗生素治疗的可能性较小.
