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Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy.
Arch Intern Med. 2011 Jan 24; 171(2):166-72.AI

Abstract

BACKGROUND

The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP.

METHODS

A prospective study of all adults hospitalized with CAP was performed from February 2007 through January 2008. To evaluate the accuracy of the test, we calculated its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The gold standard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid (definite diagnosis) and isolation in sputum (probable diagnosis). Antibiotic modifications, complications, and mortality were analyzed.

RESULTS

A total of 474 episodes of CAP were included. Streptococcus pneumoniae was the causative pathogen in 171 cases (36.1%). It was detected exclusively by urinary antigen test in 75 cases (43.8%). Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae. Specificity was 96%, positive predictive value ranged from 88.8% to 96.5%, and the positive likelihood ratio ranged from 14.6 to 19.9. The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients. Pneumonia was cured in all of them. Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test.

CONCLUSION

When its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes.

Authors+Show Affiliations

Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain. rsorde@ir.vhebron.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20876397

Citation

Sordé, Roger, et al. "Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-acquired Pneumonia to Guide Antimicrobial Therapy." Archives of Internal Medicine, vol. 171, no. 2, 2011, pp. 166-72.
Sordé R, Falcó V, Lowak M, et al. Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy. Arch Intern Med. 2011;171(2):166-72.
Sordé, R., Falcó, V., Lowak, M., Domingo, E., Ferrer, A., Burgos, J., Puig, M., Cabral, E., Len, O., & Pahissa, A. (2011). Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy. Archives of Internal Medicine, 171(2), 166-72. https://doi.org/10.1001/archinternmed.2010.347
Sordé R, et al. Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-acquired Pneumonia to Guide Antimicrobial Therapy. Arch Intern Med. 2011 Jan 24;171(2):166-72. PubMed PMID: 20876397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy. AU - Sordé,Roger, AU - Falcó,Vicenç, AU - Lowak,Michael, AU - Domingo,Eva, AU - Ferrer,Adelaida, AU - Burgos,Joaquin, AU - Puig,Mireia, AU - Cabral,Evelyn, AU - Len,Oscar, AU - Pahissa,Albert, Y1 - 2010/09/27/ PY - 2010/9/30/entrez PY - 2010/9/30/pubmed PY - 2011/3/18/medline SP - 166 EP - 72 JF - Archives of internal medicine JO - Arch Intern Med VL - 171 IS - 2 N2 - BACKGROUND: The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP. METHODS: A prospective study of all adults hospitalized with CAP was performed from February 2007 through January 2008. To evaluate the accuracy of the test, we calculated its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The gold standard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid (definite diagnosis) and isolation in sputum (probable diagnosis). Antibiotic modifications, complications, and mortality were analyzed. RESULTS: A total of 474 episodes of CAP were included. Streptococcus pneumoniae was the causative pathogen in 171 cases (36.1%). It was detected exclusively by urinary antigen test in 75 cases (43.8%). Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae. Specificity was 96%, positive predictive value ranged from 88.8% to 96.5%, and the positive likelihood ratio ranged from 14.6 to 19.9. The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients. Pneumonia was cured in all of them. Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test. CONCLUSION: When its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/20876397/Current_and_potential_usefulness_of_pneumococcal_urinary_antigen_detection_in_hospitalized_patients_with_community_acquired_pneumonia_to_guide_antimicrobial_therapy_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2010.347 DB - PRIME DP - Unbound Medicine ER -