Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia

Aaron M. Harris, Anna M. Bramley, Seema Jain, Sandra Arnold, Krow Ampofo, Wesley H. Self, Derek J. Williams, Evan J. Anderson, Carlos G. Grijalva, Jonathan Mccullers, Andrew T. Pavia, Richard G. Wunderink, Kathryn M. Edwards, Jonas M. Winchell, Lauri A. Hicks

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Abstract

Background. Specimens collected after antibiotic exposure may reduce culture-based bacterial detections. The impact on culture- independent diagnostic tests is unclear. We assessed the effect of antibiotic exposure on both of these test results among patients hospitalized with community-acquired pneumonia (CAP). Methods. Culture-based bacterial testing included blood cultures and high-quality sputum or endotracheal tube (ET) aspirates; culture-independent testing included urinary antigen testing (adults) for Streptococcus pneumoniae and Legionella pneumophila and polymerase chain reaction (PCR) on nasopharyngeal and oropharyngeal (NP/OP) swabs for Mycoplasma pneumoniae and Chlamydia pneumoniae. The proportion of bacterial detections was compared between specimens collected before and after either any antibiotic exposure (prehospital and/or inpatient) or only prehospital antibiotics and increasing time after initiation of inpatient antibiotics. Results. Of 4678 CAP patients, 4383 (94%) received antibiotics: 3712 (85%) only inpatient, 642 (15%) both inpatient and prehospital, and 29 (<1%) only prehospital. There were more bacterial detections in specimens collected before antibiotics for blood cultures (5.2% vs 2.6%; P < .01) and sputum/ET cultures (50.0% vs 26.8%; P < .01) but not urine antigen (7.0% vs 5.7%; P =.53) or NP/OP PCR (6.7% vs 5.4%; P =.31). For all diagnostic testing, bacterial detections declined with increasing time between inpatient antibiotic administration and specimen collection. Conclusions. Bacteria were less frequently detected in culture-based tests collected after antibiotics and in culture-independent tests that had longer intervals between antibiotic exposure and specimen collection. Bacterial yield could improve if specimens were collected promptly, preferably before antibiotics, providing data for improved antibiotic selection.

Original languageEnglish (US)
Article numberofx014
JournalOpen Forum Infectious Diseases
Volume4
Issue number1
DOIs
StatePublished - Nov 1 2017

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Routine Diagnostic Tests
Pneumonia
Anti-Bacterial Agents
Bacteria
Inpatients
Specimen Handling
Sputum
Antigens
Legionella pneumophila
Chlamydophila pneumoniae
Polymerase Chain Reaction
Mycoplasma pneumoniae
Streptococcus pneumoniae
Urine

All Science Journal Classification (ASJC) codes

  • Oncology
  • Clinical Neurology

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Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia. / Harris, Aaron M.; Bramley, Anna M.; Jain, Seema; Arnold, Sandra; Ampofo, Krow; Self, Wesley H.; Williams, Derek J.; Anderson, Evan J.; Grijalva, Carlos G.; Mccullers, Jonathan; Pavia, Andrew T.; Wunderink, Richard G.; Edwards, Kathryn M.; Winchell, Jonas M.; Hicks, Lauri A.

In: Open Forum Infectious Diseases, Vol. 4, No. 1, ofx014, 01.11.2017.

Research output: Contribution to journalArticle

Harris, AM, Bramley, AM, Jain, S, Arnold, S, Ampofo, K, Self, WH, Williams, DJ, Anderson, EJ, Grijalva, CG, Mccullers, J, Pavia, AT, Wunderink, RG, Edwards, KM, Winchell, JM & Hicks, LA 2017, 'Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia', Open Forum Infectious Diseases, vol. 4, no. 1, ofx014. https://doi.org/10.1093/OFID/OFX014
Harris, Aaron M. ; Bramley, Anna M. ; Jain, Seema ; Arnold, Sandra ; Ampofo, Krow ; Self, Wesley H. ; Williams, Derek J. ; Anderson, Evan J. ; Grijalva, Carlos G. ; Mccullers, Jonathan ; Pavia, Andrew T. ; Wunderink, Richard G. ; Edwards, Kathryn M. ; Winchell, Jonas M. ; Hicks, Lauri A. / Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia. In: Open Forum Infectious Diseases. 2017 ; Vol. 4, No. 1.
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title = "Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia",
abstract = "Background. Specimens collected after antibiotic exposure may reduce culture-based bacterial detections. The impact on culture- independent diagnostic tests is unclear. We assessed the effect of antibiotic exposure on both of these test results among patients hospitalized with community-acquired pneumonia (CAP). Methods. Culture-based bacterial testing included blood cultures and high-quality sputum or endotracheal tube (ET) aspirates; culture-independent testing included urinary antigen testing (adults) for Streptococcus pneumoniae and Legionella pneumophila and polymerase chain reaction (PCR) on nasopharyngeal and oropharyngeal (NP/OP) swabs for Mycoplasma pneumoniae and Chlamydia pneumoniae. The proportion of bacterial detections was compared between specimens collected before and after either any antibiotic exposure (prehospital and/or inpatient) or only prehospital antibiotics and increasing time after initiation of inpatient antibiotics. Results. Of 4678 CAP patients, 4383 (94{\%}) received antibiotics: 3712 (85{\%}) only inpatient, 642 (15{\%}) both inpatient and prehospital, and 29 (<1{\%}) only prehospital. There were more bacterial detections in specimens collected before antibiotics for blood cultures (5.2{\%} vs 2.6{\%}; P < .01) and sputum/ET cultures (50.0{\%} vs 26.8{\%}; P < .01) but not urine antigen (7.0{\%} vs 5.7{\%}; P =.53) or NP/OP PCR (6.7{\%} vs 5.4{\%}; P =.31). For all diagnostic testing, bacterial detections declined with increasing time between inpatient antibiotic administration and specimen collection. Conclusions. Bacteria were less frequently detected in culture-based tests collected after antibiotics and in culture-independent tests that had longer intervals between antibiotic exposure and specimen collection. Bacterial yield could improve if specimens were collected promptly, preferably before antibiotics, providing data for improved antibiotic selection.",
author = "Harris, {Aaron M.} and Bramley, {Anna M.} and Seema Jain and Sandra Arnold and Krow Ampofo and Self, {Wesley H.} and Williams, {Derek J.} and Anderson, {Evan J.} and Grijalva, {Carlos G.} and Jonathan Mccullers and Pavia, {Andrew T.} and Wunderink, {Richard G.} and Edwards, {Kathryn M.} and Winchell, {Jonas M.} and Hicks, {Lauri A.}",
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AU - Harris, Aaron M.

AU - Bramley, Anna M.

AU - Jain, Seema

AU - Arnold, Sandra

AU - Ampofo, Krow

AU - Self, Wesley H.

AU - Williams, Derek J.

AU - Anderson, Evan J.

AU - Grijalva, Carlos G.

AU - Mccullers, Jonathan

AU - Pavia, Andrew T.

AU - Wunderink, Richard G.

AU - Edwards, Kathryn M.

AU - Winchell, Jonas M.

AU - Hicks, Lauri A.

PY - 2017/11/1

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N2 - Background. Specimens collected after antibiotic exposure may reduce culture-based bacterial detections. The impact on culture- independent diagnostic tests is unclear. We assessed the effect of antibiotic exposure on both of these test results among patients hospitalized with community-acquired pneumonia (CAP). Methods. Culture-based bacterial testing included blood cultures and high-quality sputum or endotracheal tube (ET) aspirates; culture-independent testing included urinary antigen testing (adults) for Streptococcus pneumoniae and Legionella pneumophila and polymerase chain reaction (PCR) on nasopharyngeal and oropharyngeal (NP/OP) swabs for Mycoplasma pneumoniae and Chlamydia pneumoniae. The proportion of bacterial detections was compared between specimens collected before and after either any antibiotic exposure (prehospital and/or inpatient) or only prehospital antibiotics and increasing time after initiation of inpatient antibiotics. Results. Of 4678 CAP patients, 4383 (94%) received antibiotics: 3712 (85%) only inpatient, 642 (15%) both inpatient and prehospital, and 29 (<1%) only prehospital. There were more bacterial detections in specimens collected before antibiotics for blood cultures (5.2% vs 2.6%; P < .01) and sputum/ET cultures (50.0% vs 26.8%; P < .01) but not urine antigen (7.0% vs 5.7%; P =.53) or NP/OP PCR (6.7% vs 5.4%; P =.31). For all diagnostic testing, bacterial detections declined with increasing time between inpatient antibiotic administration and specimen collection. Conclusions. Bacteria were less frequently detected in culture-based tests collected after antibiotics and in culture-independent tests that had longer intervals between antibiotic exposure and specimen collection. Bacterial yield could improve if specimens were collected promptly, preferably before antibiotics, providing data for improved antibiotic selection.

AB - Background. Specimens collected after antibiotic exposure may reduce culture-based bacterial detections. The impact on culture- independent diagnostic tests is unclear. We assessed the effect of antibiotic exposure on both of these test results among patients hospitalized with community-acquired pneumonia (CAP). Methods. Culture-based bacterial testing included blood cultures and high-quality sputum or endotracheal tube (ET) aspirates; culture-independent testing included urinary antigen testing (adults) for Streptococcus pneumoniae and Legionella pneumophila and polymerase chain reaction (PCR) on nasopharyngeal and oropharyngeal (NP/OP) swabs for Mycoplasma pneumoniae and Chlamydia pneumoniae. The proportion of bacterial detections was compared between specimens collected before and after either any antibiotic exposure (prehospital and/or inpatient) or only prehospital antibiotics and increasing time after initiation of inpatient antibiotics. Results. Of 4678 CAP patients, 4383 (94%) received antibiotics: 3712 (85%) only inpatient, 642 (15%) both inpatient and prehospital, and 29 (<1%) only prehospital. There were more bacterial detections in specimens collected before antibiotics for blood cultures (5.2% vs 2.6%; P < .01) and sputum/ET cultures (50.0% vs 26.8%; P < .01) but not urine antigen (7.0% vs 5.7%; P =.53) or NP/OP PCR (6.7% vs 5.4%; P =.31). For all diagnostic testing, bacterial detections declined with increasing time between inpatient antibiotic administration and specimen collection. Conclusions. Bacteria were less frequently detected in culture-based tests collected after antibiotics and in culture-independent tests that had longer intervals between antibiotic exposure and specimen collection. Bacterial yield could improve if specimens were collected promptly, preferably before antibiotics, providing data for improved antibiotic selection.

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