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The Impact of Lower Respiratory Tract Sample Cultures on Outcomes in Community-Acquired Pneumonia: A Propensity

Markus Fally1, Simone Bastrup Israelsen2, Thomas Benfield2

  • 1Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|December 11, 2024
PubMed
Abstract

Insights

Collecting lower respiratory tract samples (LRTS) for bacterial testing in community-acquired pneumonia (CAP) patients did not change narrow-spectrum antibiotic use but was linked to longer treatment durations. However, LRTS testing was associated with reduced mortality and shorter hospital stays.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Clinical Microbiology

Background:

  • Community-acquired pneumonia (CAP) necessitates appropriate antibiotic selection and duration.
  • Diagnostic methods for identifying bacterial pathogens and guiding antimicrobial therapy in CAP are crucial.
  • The impact of collecting lower respiratory tract samples (LRTS) on clinical outcomes in CAP remains an area of investigation.

Purpose of the Study:

  • To evaluate the effect of collecting lower respiratory tract samples (LRTS) for bacterial microscopy, culture, and resistance (MCR) testing on patient outcomes in community-acquired pneumonia (CAP).

Main Methods:

  • A propensity score-matched (PSM) cohort study was conducted on adult patients hospitalized with CAP.
  • Primary outcome: duration of narrow-spectrum antibiotic treatment.
  • Secondary outcomes: antibiotic durations, time to discharge, and 90-day mortality, with subgroup analyses for *Streptococcus pneumoniae* and *Haemophilus influenzae*.

Main Results:

  • After PSM (n=1,434), LRTS collection did not affect narrow-spectrum antibiotic use but was associated with longer intravenous and total antibiotic durations.
  • LRTS collection was linked to a lower probability of early discharge and reduced 90-day mortality.
  • Patients with CAP due to *S. pneumoniae* or *H. influenzae* showed a higher probability of early discharge and reduced 90-day mortality.

Conclusions:

  • LRTS collection for MCR testing in CAP patients is associated with extended overall antibiotic treatment but also with reduced mortality.
  • LRTS testing may contribute to better patient outcomes, including shorter hospital stays and lower mortality rates.
  • LRTS MCR testing remains a valuable standard investigation for hospitalized CAP patients pending more sensitive etiological diagnostic methods.
Keywords:
cohort studycommunity-acquiredetiologylower respiratory tract samplespneumonia

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