Microbiological Analysis of Lower Airway Samples: Does It Influence the Outcome in Patients With Community-Acquired Pneumonia?

This prospective randomized trial examined the impact of extensive lower respiratory tract sampling and microbial analysis on treatment decisions and patient outcomes in community-acquired pneumonia (CAP). One hundred and eighteen patients were randomized to rigorous sampling (intervention group, n = 64) or standard care (control group, n = 54). The primary outcome was antibiotic therapy change based on microbiological results. Secondary outcomes included intravenous therapy duration, hospital stay length, 30-day mortality, and readmission rate. Unexpectedly, many control group patients underwent sampling at the physician's discretion, making the groups equivalent in sampling frequency. Microbiological analysis led to antibiotic therapy changes in 28% of intervention and 30% of control patients. Overall, 34% of sampled patients had treatment adjustments, generally leading to antibiotic broadening. No significant differences were observed between groups in secondary outcomes. While rigorous sampling did not significantly impact overall patient outcomes, microbiological analysis influenced treatment decisions in a substantial proportion of patients. Future studies should evaluate the effects of sampling for CAP diagnosis in settings where broader-spectrum antibiotics are the empirical treatment of choice to determine the impact on treatment decisions.