Analysis of antibiotic usage for viral community-acquired pneumonia in adults

Abstract

The rationale for the antibiotic treatment of viral community-acquired pneumonia (CAP) in adults was analyzed to develop a clinical reference standard for this condition. Clinical data from 166 patients diagnosed with viral pneumonia across 14 hospitals in Beijing from November 2010 to December 2017 were collected. The indications for medications were evaluated, and the rationale for the use of antibiotics was analyzed. A total of 163 (98.3%) patients with viral pneumonia were treated with antibiotics. A combination of C-reactive protein (CRP) and procalcitonin (PCT) was used as markers to analyze the possible indications for antibiotic use. With threshold levels set at 0.25 µg/L for PCT and 20 mg/L for CRP, the rate of unreasonable use of antibiotics was 55.2%. By contrast, at a CRP level threshold of 60 mg/L, the rate of antibiotic misuse was 77.3%. A total of 39 of the 163 (23.9%) patients did not meet the guidelines for drug selection for viral CAP in adults. The unreasonable use of antibacterial drugs for the treatment of viral CAP in adults is a serious concern. Clinicians must reduce the unnecessary use of antibiotics.

Keywords

adult / antibiotic / viral pneumonia

References

[1] Cao B, Ren LL, Zhao F, Gonzalez R, Song SF, Bai L, Yin YD, Zhang YY, Liu YM, Guo P, Zhang JZ, Wang JW, Wang C. Viral and Mycoplasma pneumoniae community-acquired pneumonia and novel clinical outcome evaluation in ambulatory adult patients in China. Eur J Clin Microbiol Infect Dis 2010; 29(11): 1443–1448

[2] Liu Y, Chen M, Zhao T, Wang H, Wang R, Cai B, Cao B, Sun T, Hu Y, Xiu Q, Zhou X, Ding X, Yang L, Zhuo J, Tang Y, Zhang K, Liang D, Lv X, Li S, Liu Y, Yu Y, Wei Z, Ying K, Zhao F, Chen P, Hou X. Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population. BMC Infect Dis 2009; 9(1): 31–39

[3] Qu JX, Gu L, Pu ZH, Yu XM, Liu YM, Li R, Wang YM, Cao B, Wang C; Beijing Network for Adult Community-Acquired Pneumonia (BNACAP). Viral etiology of community-acquired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity. BMC Infect Dis 2015; 15(1): 89–97

[4] Zhan Y, Yang Z, Chen R, Wang Y, Guan W, Zhao S. Respiratory virus is a real pathogen in immunocompetent community-acquired pneumonia: comparing to influenza like illness and volunteer controls. BMC Pulm Med 2014; 14(1): 144–152

[5] Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015; 373(5): 415–427

[6] Qu JM, Cao B. Guidelines for the diagnosis and treatment of adult community acquired pneumonia in China (2016 Edition). Chin J Tuberc Respir Dis (Zhonghua Jie He He Hu Xi Za Zhi) 2016; 39(4): 241–242 (in Chinese)

[7] Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet 2011; 377(9773): 1264–1275

[8] Galván JM, Rajas O, Aspa J. Review of non-bacterial infections in respiratory medicine: viral pneumonia. Arch Bronconeumol 2015; 51(11): 590–597

[9] Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, Thomson A; British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011; 66(Suppl 2): ii1–ii23

[10] Don M, Canciani M, Korppi M. Community-acquired pneumonia in children: what’s old? What’s new? Acta Paediatr 2010; 99(11): 1602–1608

[11] Bello S, Mincholé E, Fandos S, Lasierra AB, Ruiz MA, Simon AL, Panadero C, Lapresta C, Menendez R, Torres A. Inflammatory response in mixed viral-bacterial community-acquired pneumonia. BMC Pulm Med 2014; 14(1): 123–134

[12] Wang MM, Liu TL, Cui SN, Sun YQ, Zhang J. Comparison of serum procalcitonin levels in children with viral infection and bacterial infection. Chin J Contemp Pediatr (Zhongguo Dang Dai Er Ke Za Zhi ) 2004; 6(5): 432–434 (in Chinese)

[13] Chinese College of Emergency Physicans (CCEP). Expert consensus on clinical practice of severe pneumonia in the emergency department in China. Chin J Crit Care Med (Zhongguo Ji Jiu Yi Xue) 2016; 36(2): 97–107 (in Chinese)

[14] Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Müller B. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006; 174(1): 84–93

[15] Long W, Deng X, Zhang Y, Lu G, Xie J, Tang J. Procalcitonin guidance for reduction of antibiotic use in low-risk outpatients with community-acquired pneumonia. Respirology 2011; 16(5): 819–824

[16] Lubell Y, Blacksell SD, Dunachie S, Tanganuchitcharnchai A, Althaus T, Watthanaworawit W, Paris DH, Mayxay M, Peto TJ, Dondorp AM, White NJ, Day NP, Nosten F, Newton PN, Turner P. Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in Southeast Asia. BMC Infect Dis 2015; 15(1): 511–520

Acknowledgements

We thank the 14 hospitals for their support and collaboration with case information. We also thank the International Science Editing for editing this manuscript. This work was supported by the Key Medical Specialty Program of Sailing Plans organized by Beijing Municipal Administration of Hospitals (No. ZYLX201602); the study on new treatment methods for non-influenza virus pneumonia organized by Beijing Municipal Science and Technology Commission (No. D151100002115002); the National Science and Technology Major Project, subtopic 2; and the New Technology and Project on Intervention and Elimination of Cytokine Storm and Secondary Infection in Acute Severe Respiratory Infectious Diseases (No. 2017ZX10204401002).

Compliance with ethics guidelines

Rongmeng Jiang, Bing Han, Chang Dou, Fei Zhou, Bin Cao, and Xingwang Li declare that they have no conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

RIGHTS & PERMISSIONS

2020 Higher Education Press