Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia

Article Article scientifique Article Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia eng 2022-05-03 2022-05-03 author Chauffard Aline Stéphanie Claudia 0000-0003-0533-1071 Faculty of Medicine, University of Geneva, Geneva, Switzerland. 954367 author Bridevaux Pierre-Olivier 0000-0002-8021-0950 Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Service de Pneumologie, Centre Hospitalier du Valais Romand, Hôpital du Valais, Sion, Switzerland. 656483 Département de médecine (DEMED) author Carballo Juan Sebastian 0000-0002-8344-4293 Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 84409 Département de médecine (DEMED) author Prendki Virginie 0000-0003-1315-2938 Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland. 811987 dept de réadaptation et gériatrie (MIGRG) author Reny Jean-Luc 0000-0002-7528-7363 Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 704339 Département de médecine (DEMED) author Stirnemann Jérôme Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 793435 Département de médecine (DEMED) author Garin Nicolas Faculty of Medicine, University of Geneva, Geneva, Switzerland. Nicolas.Garin@hopitalrivierachablais.ch.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland. Nicolas.Garin@hopitalrivierachablais.ch.,Division of Internal Medicine, Hôpital Riviera Chablais, Rennaz, Switzerland. Nicolas.Garin@hopitalrivierachablais.ch.,Service de Médecine Interne, Centre Hospitalier de Rennaz, Rte du Vieux Séquoia 20, 1847, Rennaz, Switzerland. Nicolas.Garin@hopitalrivierachablais.ch. 82767 Département de médecine (DEMED) 424 10.1186/s12879-022-07423-1 35505308 1471-2334 PMC9066797 https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07423-1 Background: Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection pressure, while withholding such coverage may worsen the prognosis if an AP is causative. A clinical model predicting the presence of AP would allow targeting atypical coverage for patients most likely to benefit. Methods: This is a secondary analysis of a multicentric randomized controlled trial that included 580 adults patients hospitalized for CAP. A predictive score was built using independent predictive factors for AP identified through multivariate analysis. Accuracy of the score was assessed using area under the receiver operating curve (AUROC), sensitivity, and specificity. Results: Prevalence of AP was 5.3%. Age < 75 years (OR 2.7, 95% CI 1.2-6.2), heart failure (OR 2.6, 95% CI 1.1-6.1), absence of chest pain (OR 3.0, 95% CI 1.1-8.2), natremia < 135 mmol/L (OR 3.0, 95% CI 1.4-6.6) and contracting the disease in autumn (OR 2.7, 95% CI 1.3-5.9) were independently associated with AP. A predictive score using these factors had an AUROC of 0.78 (95% CI 0.71-0.85). A score of 0 or 1 (present in 33% of patients) had 100% sensitivity and 35% specificity. Conclusion: Use of a score built on easily obtained clinical and laboratory data would allow safe withholding of atypical antibiotic coverage in a significant number of patients, with an expected positive impact on bacterial resistance and drug adverse effects. Trial registration: NCT00818610. Atypical pathogen Community-acquired pneumonia Legionella pneumophila Mycoplasma pneumoniae Predictive factor Predictive score Adult Aged Anti-Bacterial Agents / adverse effects Antibiotic Prophylaxis Community-Acquired Infections / drug therapy Community-Acquired Infections / epidemiology Community-Acquired Infections / microbiology Humans Pneumonia / drug therapy Pneumonia / epidemiology Pneumonia / microbiology beta-Lactams / therapeutic use Dewey 616 Swiss National Science Foundation Beta-lactam monotherapy versus Beta-lactam-Macrolide association as empiric antibiotherapy strategies in non-severe hospitalized community-acquired pneumonia: a randomized, non-inferiority, open trial 120074 CH Projects 56 Département de médecine 221 false 11 Plaquettes et antithrombotiques 13 319 Groupe Perrier Arnaud (Médecine interne générale, de réhabilitation et de gériatrie) 585 BMC infectious diseases 22 1 bf81396f-72cc-4ddd-8b3e-605a233c59f5 Article (Published version) Public Article-scientifique-from-europePmc.pdf 938942 application/pdf CC BY-4.0 8799922f668b13a348812515b4b66ad66758358bf6d328a8395338be416cce42 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia	BMC infectious diseases	2022	88	199
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Chauffard, Aline Stéphanie Claudia

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