Utility of Mycoplasma IgM Serology in Hospitalized Patients

Abstract

SESSION TITLE: Quality Improvement 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Mycoplasma IgM serology is frequently ordered for hospitalized patients with pneumonia. This study aims to understand the impact of positive Mycoplasma IgM serology on the use of antibiotics that cover atypical organisms in such patients. METHODS: We conducted a retrospective study of 120 patients with positive IgM serology who were hospitalized at a regional Cleveland Clinic hospital over a 12-month period, February 2015 to February 2016. Baseline patient characteristics included demographic characteristics, CURB 65 score, chest x-ray findings, hospital length of stay and all-cause mortality. Data on atypical antibiotic usage was obtained - use of atypical antibiotic before and after positive IgM testing, duration of antibiotic, and titration of antibiotics following positive IgM serology. We hypothesized that a positive IgM did not result in the change or addition of atypical antibiotic usage following positive IgM serology. McNemar test of before and after comparisons was used to identify the change in the overall prevalence of atypical antibiotic use following a positive IgM serology. RESULTS: - 120 patients had positive Mycoplasma IgM serology (n=120). The mean age was 59.3 (±19.8) years with 67.5% females. Majority were Caucasians (84.8%). 41.8% were current smokers, 42.2% had COPD, and 29.9% had a CURB 65score of >2. - 82.5% of patients had atypical antibiotic coverage (AAC) on the date of Mycoplasma IgM testing, whereas 89.1% had AAC after the test results were available. AAC was newly added in 17 (16.3%) patients. There was no significant overall increase in prevalence of AAC after test result (p=0.13). In a subgroup analysis, amongst Intensive Care Unit (ICU) patients there was a significant increase in AAC after testing (76% AAC before IgM testing and 95.2% AAC following positive IgM, p=0.02). CONCLUSIONS: Positive IgM serology among ICU patients helped physicians to add atypical antibiotic coverage for treatment of Mycoplasma pneumonia. Among patients in regular nursing floor, a positive IgM serology for Mycoplasma pneumonia did not impact the overall prevalence of atypical antibiotic usage. CLINICAL IMPLICATIONS: Hospitalized patients were started on an atypical antibiotic on admission based on clinical findings, which suggests that Mycoplasma IgM has a limited role in patient management. In ICU patients, testing for Mycoplasma IgM is beneficial as it directs antibiotic coverage. DISCLOSURE: The following authors have nothing to disclose: Sidra Khalid, Amrita Bath, Alia Poore, Gaurav Kistangari, Anil Kumar Changarath Vijayan No Product/Research Disclosure Information