Microbiological Diagnosis and Antibiotic Therapy in Patients with Community-Acquired Pneumonia and Acute COPD Exacerbati
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PNEUMONIA GUIDELINES
Microbiological Diagnosis and Antibiotic Therapy in Patients with Community-Acquired Pneumonia and Acute COPD Exacerbation in Daily Clinical Practice: Comparison to Current Guidelines Angelika Reissig • Christine Mempel • Ulrike Schumacher • Roberto Copetti • Florian Gross • Stefano Aliberti Received: 1 December 2012 / Accepted: 18 March 2013 / Published online: 6 April 2013 Ó Springer Science+Business Media New York 2013
Abstract Background The aim of this secondary analysis was to evaluate current microbiological approaches, microbiology, and antibiotic therapy in patients with communityacquired pneumonia (CAP) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in clinical practice and to compare them with current international guidelines. Methods A total of 362 patients with suspected CAP were enrolled in 14 European centers in a prospective multicenter study.
A. Reissig (&) Department of Internal Medicine I, Pneumology & Allergology, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07740 Jena, Germany e-mail: [email protected] C. Mempel Department of Geriatric Medicine, Helios Clinic, Erfurt, Germany U. Schumacher Centre for Clinical Studies, Friedrich-Schiller-University Jena, Jena, Germany R. Copetti Emergency Department, Latisana General Hospital, Latisana, Italy F. Gross Department of Internal Medicine, Helfenstein Clinic, Geislingen, Germany S. Aliberti Department of Health Science, University of Milan Bicocca, AO San Gerardo, Monza, Italy
Results A total of 279 inpatients (CAP, n = 222; AECOPD, n = 57) were evaluated. A total of 83 (37 %) CAP patients and 25 (44 %) AECOPD patients did not undergo any microbiological tests. In patients with CAP/AECOPD, blood culture was performed in 109 (49 %)/16 (28.1 %), urinary antigen tests for Legionella pneumophila in 67 (30 %)/9 (16 %), and sputum investigation in 55 (25 %)/17 (30 %), respectively. The most frequent pathogens in CAP were Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, L. pneumophila, Staphylococcus aureus, and Enterobacter cloacae; in AECOPD they were Escherichia coli, Haemophilus haemolyticus, Haemophilus influenzae, and Moraxella catarrhalis. All CAP patients (mean = 11.1 days) and 35 (61.4 %) of AECOPD patients (mean = 8.9 days) received antibiotics. CAP patients were given mostly aminopenicillin with blactamase inhibitors and AECOPD patients were given mostly cephalosporins. Conclusions Pathogens isolated in CAP and AECOPD and the antibiotic therapy used are in good accordance with the guidelines. Blood culture, recommended for all CAP patients, was performed in only 50 % of the cases and antibiotic therapy lasted longer than the suggested 5–7 days. Therefore, international guidelines regarding performance of blood culture and duration of antibiotic therapy should be adopted more often. This duration was independent of the number of isolated pathogens and number of symptoms on admission. Therefore, the question arises as to whether
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