Value of rapid aetiological diagnosis in optimization of antimicrobial treatment in bacterial community acquired pneumonia.

Mareković, Ivana and Plečko, Vanda and Boras, Zagorka and Pavlović, Ladislav and Budimir, Ana and Bošnjak, Zrinka and Puretić, Hrvoje and Žele-Starčević, Lidija and Kalenić, Smilja (2012) Value of rapid aetiological diagnosis in optimization of antimicrobial treatment in bacterial community acquired pneumonia. Collegium Antropologicum, 36 (2). pp. 401-8. ISSN 0350-6134

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Abstract

In 80 adult patients with community acquired pneumonia (CAP) conventional microbiological methods, polymerase chain reaction (PCR) and serum C-reactive protein (CRP) levels were performed and the appropriateness of the empirical antimicrobial treatment was evaluated according to bacterial pathogen detected. The aetiology was determined in 42 (52.5%) patients, with Streptococcus pneumoniae as the most common pathogen. PCR applied to bronchoalveolar lavage (BAL) provided 2 and PCR on sputum samples 1 additional aetiological diagnosis of CAP The mean CRP values in the S. pneumoniae group were not significantly higher than in the group with other aetiological diagnoses (166.89 mg/L vs. 160.11 mg/L, p = 0.457). In 23.8% (10/42) of patients with determined aetiology, the empirical antimicrobial treatment was inappropriate. PCR tests need further investigation, particularly those for the atypical pathogens, as they are predominant in inappropriately treated patients. Our results do not support the use of CRP as a rapid test to guide the antimicrobial treatment in patients with CAP.

Abstract in Croatian

ZNAČENJE BRZE ETIOLOŠKE DIJAGNOZE U OPTIMIZACIJI ANTIMIKROBNOG LIJEČENJA BOLESNIKA S IZVANBOLNIČKOM PNEUMONIJOM UZROKOVANOM BAKTERIJAMA ----- Kod 80 bolesnika s izvanbolničkom pneumonijom napravljene su konvencionalne mikrobiološke pretrage i lančana reakcija polimeraze (PCR), te određen C-reaktivni protein (CRP) u serumu. Adekvatnost empirijskog antimikrobnog liječenja evaluirana je prema detektiranom bakterijskom patogenu. Etiologija je utvrđena kod 42 (52,5%) bolesnika, a najčešći patogen bio je Streptococcus pneumoniae. PCR-om na uzorcima bronhoalveolarnih lavata i sputuma utvrđena je etiološka dijagnoza kod 2 odnosno 1 bolesnika kod kojih to nije bilo moguće s konvencionalnim mikrobiološkim metodama. Prosječne CRP vrijednosti kod bolesnika sa S. pneumoniae nisu bile statistički značajno veće u usporedbi s onima kod bolesnika s drugom etiologijom pneumonije (166,89 mg/L vs.160,11 mg/L, p=0,457). Kod 23.8% (10/42) bolesnika s utvrđenom etiologijom empirijsko antimikrobno liječenje bilo je nedekvatno. PCR metode u dijagnostici izvanbolničkih pneumonija zahtijevaju daljnje istraživanje. To se osobito odnosi na PCR metode za detekciju atipičnih patogena budući da oni prevladavaju kod neadekvatno liječenih bolesnika. Rezultati ovog istraživanja ne pokazuju da bi CRP bio koristan kao brzi test prema kojem bi se usmjeravalo antimikrobno liječenje kod bolesnika s izvanbolničkom pneumonijom.

Item Type: Article
MeSH: Aged ; Anti-Bacterial Agents/therapeutic use ; C-Reactive Protein/metabolism ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/microbiology ; Female ; Humans ; Male ; Microbiological Techniques/methods ; Middle Aged ; Pneumonia, Bacterial/diagnosis ; Pneumonia, Bacterial/drug therapy ; Pneumonia, Bacterial/microbiology ; Polymerase Chain Reaction/methods
Departments: Katedra za medicinsku mikrobiologiju i parazitologiju
Depositing User: Marijan Šember
Status: Published
Creators:
CreatorsEmail
Mareković, IvanaUNSPECIFIED
Plečko, VandaUNSPECIFIED
Boras, ZagorkaUNSPECIFIED
Pavlović, LadislavUNSPECIFIED
Budimir, AnaUNSPECIFIED
Bošnjak, ZrinkaUNSPECIFIED
Puretić, HrvojeUNSPECIFIED
Žele-Starčević, LidijaUNSPECIFIED
Kalenić, SmiljaUNSPECIFIED
Date: June 2012
Date Deposited: 14 Jan 2013 13:43
Last Modified: 14 Jan 2013 13:43
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/1747

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