Highlights
- •There is lack of evidence that etiological investigation influences outcomes in CAP.
- •In a prospective study, we evaluate if microbial identification impacts mortality.
- •Etiology identification was not significantly associated with mortality (aOR=1.36, p=0.2).
- •This lack of association was verified in all drug resistant pathogen risk groups.
- •Results of etiological investigation have a limited influence in CAP management.
Abstract
Introduction
There is lack of evidence that etiological investigation influences outcomes in community-acquired
pneumonia (CAP). Guidelines recommend diverse approaches to this matter. Our aim was
to find if etiological investigation has an impact on CAP management and outcomes.
Methods
Prospective cohort study, conducted over a two years’ period, in a community-based
hospital, including all adult patients with CAP. Univariate and multivariate logistic
regression modeling were performed to understand the association of etiological identification
with CAP outcomes, particularly hospital mortality.
Results
A total of 660 cases of CAP were included, with a mean±sd age of 74±15 years and 58.9%
of males. Etiology was documented in 33% of cases. Antibiotic (ATB) was modified in
148 patients, in 51 (34%) motivated by microbiological results. There was no significant
impact on hospital mortality of microbiological documentation (35.5% vs 31.2%, p=0.352), or
the fact that ATB was modified due to microbiological findings (27.0% vs 36.9%, p=0.272).
When stratified by 3 subgroups of risk for drug-resistant pathogens (zero, one or
two risk factors: being bed-ridden and/or ATB use within 90 days), etiology identification
still did not influence mortality. When adjusted for CURB-65, Charlson's index, being
bed-ridden, having had ATB or hospitalization within 90 days or coming from long-term
care facilities, microbial identification was not associated with lower mortality.
Conclusion
Etiological investigation of patients with CAP does not have an association with hospital
mortality, irrespective of the risk for drug-resistant pathogens.
Keywords
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Article info
Publication history
Published online: December 06, 2022
Accepted:
November 23,
2022
Received in revised form:
November 21,
2022
Received:
July 30,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
