OBJECTIVE: To determine the clinical utility of diagnosing Legionella pneumonia by urinary antigen testing (LPUAT) in a low prevalence centre. DESIGN: The results of LPUATs were abstracted and analyzed from the authors' laboratory information system. Medical records were reviewed in detail for all positive tests and a random sample of 50 negative tests. SETTING: The Queen Elizabeth II Health Sciences Centre, a large university hospital complex. POPULATION STUDIED: Patients who were admitted from the emergency room with pneumonia or who had developed pneumonia in hospital and who had a LPUAT performed between April 1998 and October 2000. MAIN RESULTS: One thousand one hundred fifty-four tests were performed on 1007 patients. Seven patients had nine positive LPUATs. Three of these patients had confirmed Legionella pneumophila pneumonia. Three others had probable or possible L pneumophila pneumonia. There was one probable false positive. Six of the seven patients were already on empirical anti-L pneumophila therapy. Of the 50 negative tests reviewed in detail, 31 patients were on one of the antibiotics of choice for L pneumophila at the time the test was ordered; in 21 (68%) of these patients the negative result did not lead to a change in therapy. CONCLUSIONS: The cost to diagnose each case of Legionella pneumonia by LPUAT was approximately $5,770 and most patients were already on appropriate antibiotics. In patients with negative tests, antibiotics were often not changed in response to the test result. Rigorous screening of patients is required to increase pretest probability for LPUAT to be justified.
OBJECTIVE: To determine the clinical utility of diagnosing Legionella pneumonia by urinary antigen testing (LPUAT) in a low prevalence centre. DESIGN: The results of LPUATs were abstracted and analyzed from the authors' laboratory information system. Medical records were reviewed in detail for all positive tests and a random sample of 50 negative tests. SETTING: The Queen Elizabeth II Health Sciences Centre, a large university hospital complex. POPULATION STUDIED: Patients who were admitted from the emergency room with pneumonia or who had developed pneumonia in hospital and who had a LPUAT performed between April 1998 and October 2000. MAIN RESULTS: One thousand one hundred fifty-four tests were performed on 1007 patients. Seven patients had nine positive LPUATs. Three of these patients had confirmed Legionella pneumophila pneumonia. Three others had probable or possible L pneumophila pneumonia. There was one probable false positive. Six of the seven patients were already on empirical anti-L pneumophila therapy. Of the 50 negative tests reviewed in detail, 31 patients were on one of the antibiotics of choice for L pneumophila at the time the test was ordered; in 21 (68%) of these patients the negative result did not lead to a change in therapy. CONCLUSIONS: The cost to diagnose each case of Legionella pneumonia by LPUAT was approximately $5,770 and most patients were already on appropriate antibiotics. In patients with negative tests, antibiotics were often not changed in response to the test result. Rigorous screening of patients is required to increase pretest probability for LPUAT to be justified.
Authors: B J Marston; J F Plouffe; T M File; B A Hackman; S J Salstrom; H B Lipman; M S Kolczak; R F Breiman Journal: Arch Intern Med Date: 1997 Aug 11-25
Authors: J Domínguez; N Galí; L Matas; P Pedroso; A Hernández; E Padilla; V Ausina Journal: Eur J Clin Microbiol Infect Dis Date: 1999-12 Impact factor: 3.267