Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

Carugati, Manuela; Aliberti, Stefano; Reyes, Luis Felipe; Franco Sadud, Ricardo; Irfan, Muhammad; Prat, Cristina; Soni, Nilam J.; Faverio, Paola; Gori, Andrea; Blasi, Francesco; Restrepo, Marcos I.

Fifthly, our study is among the first to evaluate the concordance of real-life diagnostic testing with international guidelines. To the best of our knowledge, only JENKINS et al. [12] made a similar attempt. They analysed the concordance of diagnostic testing practices retrospectively in a cohort of adult inpatients with CAP with the 2007 IDSA/ATS guidelines and reported over-testing with blood cultures. Our study revealed that real-life diagnostic testing was not concordant with IDSA/ATS or ERS guidelines in the vast majority of the patients. Specifically, the discordance with the IDSA/ATS guidelines was mainly due to over-testing. This situation may be explained by the restrictive testing recommended by the IDSA/ATS guidelines. Of note, under-testing was also a cause of discordance with the IDSA/ATS guidelines and was more frequently encountered in North America than in Europe. Discordance with ERS guidelines was mainly due to under-testing, as a result of the extensive testing approach recommended by these guidelines. Over-testing was also identified as a cause of discordance with the ERS guidelines. This event was more frequently reported in Europe than in North America. We were intrigued by European clinicians' extensive ordering of diagnostic tests, even beyond what is recommended by the ERS guidelines. Insurance and healthcare system-related factors may have shaped the diagnostic approach both of European and North American clinicians. Nonetheless, the significant discrepancies between real-life diagnostic testing and IDSA/ATS/ERS recommended testing is worrisome and further studies aimed at assessing the clinical and economic implications of the testing approach proposed by the IDSA/ATS guidelines, the testing approach proposed by the ERS guidelines, and real-life diagnostic testing are needed.