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Does etiological investigation have an impact on the outcomes of community-acquired pneumonia? – A prospective cohort study

  • J. Vasco Barreto
    Correspondence
    Corresponding author at: Rua Dr. Eduardo Torres, Senhora da Hora 4464-513, Portugal.
    Affiliations
    Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Internal Medicine Service, Rua Dr. Eduardo Torres, Senhora da Hora 4464-513, Portugal

    ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, Porto 4050-313, Portugal
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  • Cláudia Camila Dias
    Affiliations
    Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal

    [email protected] - Health Research Netwok – From Lab to the Community, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal
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  • Teresa Cardoso
    Affiliations
    ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, Porto 4050-313, Portugal

    Intensive Care Unit (UCIP) and Hospital Infection Control Committee, Hospital de Santo António, Oporto University Hospital Center, University of Porto, Largo Prof. Abel Salazar, Porto 4099-001, Portugal
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Published:December 06, 2022DOI:https://doi.org/10.1016/j.ejim.2022.11.034

      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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