Community-Acquired Pneumonia Clinical Trial
Official title:
Prospective Study on Benefits Derived From Microbiological Tests in Community-Acquired Pneumonia
The hypothesis is that community-acquired pneumonia is usually a monomicrobial infection. Therefore, early detection of the etiology allows to select the most active, narrow-spectrum, and cheap, and less toxic antibiotic agent.
In community-acquired pneumonia, identification of the etiologic agent has theoretically
important advantages. For individual patients, it facilitates the administration of a
targeted, narrow-spectrum antibiotic therapy that may improve the efficacy of treatment, and
reduces risks of antibiotic-related toxicity. For the community, microbiologic results
contribute to understanding the local microbial epidemiology of community-acquired pneumonia
and the antimicrobial resistance patterns of pathogens, information that is essential in the
instauration or modification of empiric treatment regimens.
Guidelines recommend that all admitted patients with community-acquired pneumonia should
have a collection of two sets of blood cultures, a good quality sputum sample for Gram stain
and culture, a sample of pleural fuid if present and, for severe patients, an urine sample
for antigen detection. In contrast, several prospective studies (usually without include
urinary tests) concluded that these microbiological studies have limited value in the
management of patients admitted with community-acquired pneumonia.
In addition, microbiological studies could provide erroneous or incomplete information.
Thus, investigations has showed false-positive results from pneumococcal antigen detection
in urine caused by a frequent persistence of positivity after infection or a nasopharyngeal
or bronchial colonization. Other authors suggested that community-acquired pneumonia is a
polymicrobial infection; consequently, despite the detection of a true microorganism,
treatment needs to be also addressed against other potential pathogenic agents.
The purpose of the study is to assess the clinical and the economic derived from the initial
microbiological studies, including antigen detection tests in urine for Streptococcus
pneumoniae and Legionella pneumophila, in patients with community-acquired pneumonia.
The hypothesis is that community-acquired pneumonia is usually a monomicrobial infection.
Therefore, early detection of the etiology allows to select the most active,
narrow-spectrum, and cheap, and less toxic antibiotic agent.
;
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