Urinary antigen testing may help target antibiotics for pneumonia
Positive pneumococcal urinary antigen testing (PUAT) results among patients hospitalized with community-acquired pneumonia (CAP) was associated with earlier time to de-escalation of antibiotics, according to a single-center study published last week in Open Forum Infectious Diseases.
In the retrospective study, conducted at New York University Langone Health, researchers analyzed hospitalized CAP patients who had PUAT performed in 2019, comparing antibiotic de-escalation and outcomes in those who tested positive and negative. PUAT is a rapid, non-invasive assay that can aid in the diagnosis of CAP caused by Streptococcus pneumoniae. It has also been viewed as a potential antibiotic stewardship tool that might improve time to targeted, narrow-spectrum antibiotics and reduce use of broad-spectrum agents.
Of the 910 patients included in the analysis, 121 (13.3%) had a positive PUAT result and 789 (86.7%) had a negative result. Initial antibiotic de-escalation from a broad-spectrum antibiotic to a narrow-spectrum agent was similar in the PUAT-positive and -negative groups (82.9% vs 81.2%), but median time to de-escalation (interquartile range [IQR]) was similar in the PUAT-positive group (1 [IQR, 0 to 2] day vs 1 [IQR, 1 to 2] day). Within 24 hours of PUAT, more patients in the PUAT-positive group had atypical coverage discontinued (61.3% vs 47.2%). Patients with positive PUAT results were also less likely to have antibiotics escalated.
Among the PUAT-positive group, unadjusted analysis showed a shorter length of stay in patients who were de-escalated compared to those who were not de-escalated or required escalation (6 [IQR 4-10] days vs 8 [IQR 7-12]) days), with no difference in the incidence of Clostridioides difficile, in-hospital mortality, or 30-day infection-related readmission.
The authors say the findings support the use of PUAT in conjunction with additional stewardship interventions.
"In order to have the greatest impact, testing should be considered on all patients admitted with a diagnosis of CAP, and coordinated efforts should be made with microbiology personnel to ensure appropriate workflows are established for timely PUAT results," they wrote.
Oct 22 Open Forum Infect Dis abstract
H3N2 strain makes early mark on Europe's flu season
Though flu cases are still low in Europe, an unusually early spike in Croatia is a sign that the 2021-22 flu season could be severe for older people, the European Centre for Disease Prevention and Control (ECDC) said today.
The ECDC said the main subtype detected in the region over the past month is influenza A H3N2, which is known for disproportionately affecting older people and has been linked to lower vaccine effectiveness. It said the early signals suggest the season could be severe for older people but noted the timing of flu circulation may vary among countries.
In a statement, Pasi Penttinen, MD, PhD, MPH, who leads the ECDC's flu program, said it's impossible to predict what the flu season will look like. He emphasized, however, that a steep increase in flu in the current COVID-19 pandemic setting could have serious consequences for people with weakened immune systems and place an extra burden on healthcare systems.
"It is therefore important that we take the necessary precautions and protect those that are most at risk," he said, adding that nonpharmaceutical interventions that worked against COVID-19 are also effective against flu. Penttinen also urged health and nursing home workers to get vaccinated against both diseases ahead of winter.
Oct 26 ECDC statement
Globally, flu activity is still at lower-than-expected levels, the World Health Organization (WHO) said today in an update that roughly covers the first half of October. Influenza A and B detections were reported from some regions, with both reported in North America. Influenza B was predominant in Caribbean and Central American countries, as well as in South Asia. Influenza A was the main virus in African countries that reported flu cases.
Of the respiratory specimens that tested positive for flu at national labs, 65.6% were influenza B, slightly lower than the WHO last global flu update. Of subtyped influenza A viruses, 66% were H3N2.
Also, countries in both hemispheres reported increased respiratory syncytial virus activity.
Oct 25 WHO global flu update