caa a22 4500 606156186 CHVBK 20210128100607.0 cr unu---uuuuu 210128e20151201xx s 000 0 eng 10.1007/s10096-015-2503-x doi (NATIONALLICENCE)springer-10.1007/s10096-015-2503-x Severe community-acquired pneumonia and positive urinary antigen test for S. pneumoniae [Elektronische Daten] amoxicillin is associated with a favourable outcome [V. Blanc, A. Mothes, A. Smetz, I. Timontin, M. Guardia, A. Billiemaz, J. Dellamonica, M. Vassallo, D. Néri, S. Chadapaud, A.-L. Toyer, P. Del Guidice, A. Fribourg, S. Léotard, I. Nicolle, P.-M. Roger] Positive urinary antigen tests (UAT) for pneumococcal infection in community-acquired pneumonia (CAP) may lead to targeted antibiotic therapy. We report an audit aimed at defining the link between mortality and targeted therapy. We conducted a retrospective multicentre audit of patients with severe CAP for whom a UAT was positive for S. pneumoniae. Patients admitted from January 2010 to December 2013 to 8 medical centres (from A to H) were included. Co-morbidities were defined by the specific treatment administered before hospital care, or if the diagnosis was newly established during the hospital stay. We used the Pneumonia Severity Index (PSI) to assess disease severity. Only patients with PSI > 90 were included. Antibiotic treatments and the PSI were extracted from patients' charts. Amoxicillin had to be prescribed as a targeted antibiotic treatment or at the time of antibiotic reassessment. A total of 389 patients were included. The mean (±STD) PSI score was 128 ± 29; 38.9% of the patients had a class 5 PSI score. Intensive care was required for 36.6% of the patients. Amoxicillin was initially prescribed in 47 cases (12.1%) and in 34 cases after reassessment (8.7%). In logistic regression analysis, we found three parameters associated with mortality: being hospitalised in institution D, class 5 PSI score, and metastatic cancer. In contrast, three antibiotic regimens were protective factors, including targeted therapy: OR = 0.09, p < 0.001. In the context of severe CAP with positive UAT for S. pneumoniae, targeted therapy was associated with a reduction in mortality. Springer-Verlag Berlin Heidelberg, 2015 Blanc V. Microbiologie, Centre Hospitalier d'Antibes, Antibes, France aut Mothes A. Médecine Interne, Centre Hospitalier de Draguignan, Draguignan, France aut Smetz A. Microbiologie, Centre Hospitalier de Draguignan, Draguignan, France aut Timontin I. Pneumologie, Centre Hospitalier d'Antibes, Antibes, France aut Guardia M. Réanimation Polyvalente, Clinique Les Fleurs, Ollioules, France aut Billiemaz A. SELAS Laboratoire Billiemaz, Toulon, France aut Dellamonica J. Réanimation Médicale, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Nice, France aut Vassallo M. Médecine Interne, Centre Hospitalier de Cannes, Cannes, France aut Néri D. Microbiologie, Centre Hospitalier de Cannes, Cannes, France aut Chadapaud S. Infectiologie, Centre Hospitalier de Hyères, Hyères, France aut Toyer A.-L Microbiologie, Centre Hospitalier de Hyères, Hyères, France aut Del Guidice P. Dermato-Infectiologie, Centre Hospitalier de Fréjus-St-Raphael, Saint-Raphaël, France aut Fribourg A. Microbiologie, Centre Hospitalier de Fréjus-St-Raphael, Saint-Raphaël, France aut Léotard S. Microbiologie, Centre Hospitalier de Grasse, Grasse, France aut Nicolle I. Pneumologie, Centre Hospitalier de Grasse, Grasse, France aut Roger P.-M Infectiologie, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Hôpital de l'Archet 1, BP 3079, 06202, Nice, France aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/12(2015-12-01), 2455-2461 0934-9723 34:12<2455 2015 34 10096 https://doi.org/10.1007/s10096-015-2503-x text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-015-2503-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Blanc V. Microbiologie, Centre Hospitalier d'Antibes, Antibes, France aut NATIONALLICENCE 700 1- Mothes A. Médecine Interne, Centre Hospitalier de Draguignan, Draguignan, France aut NATIONALLICENCE 700 1- Smetz A. Microbiologie, Centre Hospitalier de Draguignan, Draguignan, France aut NATIONALLICENCE 700 1- Timontin I. Pneumologie, Centre Hospitalier d'Antibes, Antibes, France aut NATIONALLICENCE 700 1- Guardia M. Réanimation Polyvalente, Clinique Les Fleurs, Ollioules, France aut NATIONALLICENCE 700 1- Billiemaz A. SELAS Laboratoire Billiemaz, Toulon, France aut NATIONALLICENCE 700 1- Dellamonica J. Réanimation Médicale, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Nice, France aut NATIONALLICENCE 700 1- Vassallo M. Médecine Interne, Centre Hospitalier de Cannes, Cannes, France aut NATIONALLICENCE 700 1- Néri D. Microbiologie, Centre Hospitalier de Cannes, Cannes, France aut NATIONALLICENCE 700 1- Chadapaud S. Infectiologie, Centre Hospitalier de Hyères, Hyères, France aut NATIONALLICENCE 700 1- Toyer A.-L Microbiologie, Centre Hospitalier de Hyères, Hyères, France aut NATIONALLICENCE 700 1- Del Guidice P. Dermato-Infectiologie, Centre Hospitalier de Fréjus-St-Raphael, Saint-Raphaël, France aut NATIONALLICENCE 700 1- Fribourg A. Microbiologie, Centre Hospitalier de Fréjus-St-Raphael, Saint-Raphaël, France aut NATIONALLICENCE 700 1- Léotard S. Microbiologie, Centre Hospitalier de Grasse, Grasse, France aut NATIONALLICENCE 700 1- Nicolle I. Pneumologie, Centre Hospitalier de Grasse, Grasse, France aut NATIONALLICENCE 700 1- Roger P.-M Infectiologie, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Hôpital de l'Archet 1, BP 3079, 06202, Nice, France aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/12(2015-12-01), 2455-2461 0934-9723 34:12<2455 2015 34 10096