Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study

Abstract

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1), sputum culture (61.8), Legionella urinary antigen test (30.1), pneumococcal urinary antigen test (30.0), viral testing (14.9), acute-phase serology (8.8), bronchoalveolar lavage culture (8.4) and pleural fluid culture (3.2). A pathogen was detected in 1173 (36.5) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7 and 23.9 of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5 versus 9.8; p<0.01), while ERS concordance was higher in North America than in Europe (33.5 versus 19.5; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations. © ERS 2018.