RT Journal Article
SR Electronic
T1 Relation Between Chest Radiography Results and Antibiotic Initiation in Community-Acquired Pneumonia Management by General Practitioners
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 509
OP 517
DO 10.1370/afm.3179
VO 22
IS 6
A1 Pinot, Juliette
A1 Gilberg, Serge
A1 Laouénan, Cédric
A1 Alfaiate, Toni
A1 Ecollan, Marie
A1 Cussac, Fanny
A1 Pecqueur, Raphaël
A1 Revel, Marie-Pierre
A1 Vartanian, Cyrille
A1 Partouche, Henri
A1 Duval, Xavier
A1 Le Bel, Josselin
YR 2024
UL http://www.annfammed.org/content/22/6/509.abstract
AB PURPOSE For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR.METHODS We conducted a prospective cross-sectional study in general practice in France. From November 2017 to December 2019, adult patients with clinically suspected CAP after CR were included. Radiographs were categorized as CAP positive or CAP negative. We analyzed patient characteristics and antibiotic initiation according to CR results.RESULTS A total of 259 patients were included in the study. Median age was 58.0 years (interquartile range, 41.0-71.0 years); 249 (96.1%) patients had not received antibiotics before inclusion, and 144 (55.6%) had a positive CR. Patients with positive CR were clinically more severe than those with negative CR, with longer-lasting symptoms. Antibiotics were initiated for 142/143 (99.3% [95% CI, 97.9%-100.0%]) patients with positive CR and 79/115 (68.7% [95% CI, 60.2%-77.2%]) with negative CR (P < .001). Among the 115 CR-negative patients, clinical characteristics that were significantly different between patients for whom antibiotics were initiated or not did not appear to be clinically relevant.CONCLUSIONS For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.