Luis Molinos1, Rafael Zalacain2, Rosario Menéndez3, Soledad Reyes3, Alberto Capelastegui4, Catia Cillóniz5, Olga Rajas6, Luis Borderías7, Juan J Martín-Villasclaras8, Salvador Bello9, Inmaculada Alfageme10, Felipe Rodríguez de Castro11, Jordi Rello12, Juan Ruiz-Manzano13, Albert Gabarrús5, Daniel M Musher14, Antoni Torres5. 1. 1 Servicio de Neumología, Hospital Universitario Central Asturias, Oviedo, Spain. 2. 2 Servicio de Neumología, Hospital de Cruces, Baracaldo (Bizkaia), Spain. 3. 3 Servicio de Neumología, ISS/Hospital Universitario La Fe, Valencia, CIBERES, Spain. 4. 4 Servicio de Neumología, Hospital de Galdakao (Bizkaia), Spain. 5. 5 Servei de Pneumologia, Institut Clinic del Torax, IDIBAPS, Universitat de Barcelona, CIBERES, GRS, Spain; and. 6. 6 Servicio de Neumología, Hospital de la Princesa, Madrid, Spain. 7. 7 Servicio de Neumología, Hospital San Jorge, Huesca, Spain. 8. 8 Servicio de Neumología, Hospital Carlos Haya, Malaga, Spain. 9. 9 Servicio de Neumología, Hospital Miguel Servet, Zaragoza, Spain. 10. 10 Servicio de Neumología, Hospital de Valme, Sevilla, Spain. 11. 11 Servicio de Neumología, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain. 12. 12 Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Spain. 13. 13 Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, Spain. 14. 14 Infectious Disease Section, Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Abstract
RATIONALE: Detection of the C-polysaccharide of Streptococcus pneumoniae in urine by an immune-chromatographic test is increasingly used to evaluate patients with community-acquired pneumonia. OBJECTIVES: We assessed the sensitivity and specificity of this test in the largest series of cases to date and used logistic regression models to determine predictors of positivity in patients hospitalized with community-acquired pneumonia. METHODS: We performed a multicenter, prospective, observational study of 4,374 patients hospitalized with community-acquired pneumonia. MEASUREMENTS AND MAIN RESULTS: The urinary antigen test was done in 3,874 cases. Pneumococcal infection was diagnosed in 916 cases (21%); 653 (71%) of these cases were diagnosed exclusively by the urinary antigen test. Sensitivity and specificity were 60 and 99.7%, respectively. Predictors of urinary antigen positivity were female sex; heart rate≥125 bpm, systolic blood pressure<90 mm Hg, and SaO2<90%; absence of antibiotic treatment; pleuritic chest pain; chills; pleural effusion; and blood urea nitrogen≥30 mg/dl. With at least six of all these predictors present, the probability of positivity was 52%. With only one factor present, the probability was only 12%. CONCLUSIONS: The urinary antigen test is a method with good sensitivity and excellent specificity in diagnosing pneumococcal pneumonia, and its use greatly increased the recognition of community-acquired pneumonia due to S. pneumoniae. With a specificity of 99.7%, this test could be used to direct simplified antibiotic therapy, thereby avoiding excess costs and risk for bacterial resistance that result from broad-spectrum antibiotics. We also identified predictors of positivity that could increase suspicion for pneumococcal infection or avoid the unnecessary use of this test.
RATIONALE: Detection of the C-polysaccharide of Streptococcus pneumoniae in urine by an immune-chromatographic test is increasingly used to evaluate patients with community-acquired pneumonia. OBJECTIVES: We assessed the sensitivity and specificity of this test in the largest series of cases to date and used logistic regression models to determine predictors of positivity in patients hospitalized with community-acquired pneumonia. METHODS: We performed a multicenter, prospective, observational study of 4,374 patients hospitalized with community-acquired pneumonia. MEASUREMENTS AND MAIN RESULTS: The urinary antigen test was done in 3,874 cases. Pneumococcal infection was diagnosed in 916 cases (21%); 653 (71%) of these cases were diagnosed exclusively by the urinary antigen test. Sensitivity and specificity were 60 and 99.7%, respectively. Predictors of urinary antigen positivity were female sex; heart rate≥125 bpm, systolic blood pressure<90 mm Hg, and SaO2<90%; absence of antibiotic treatment; pleuritic chest pain; chills; pleural effusion; and blood ureanitrogen≥30 mg/dl. With at least six of all these predictors present, the probability of positivity was 52%. With only one factor present, the probability was only 12%. CONCLUSIONS: The urinary antigen test is a method with good sensitivity and excellent specificity in diagnosing pneumococcal pneumonia, and its use greatly increased the recognition of community-acquired pneumonia due to S. pneumoniae. With a specificity of 99.7%, this test could be used to direct simplified antibiotic therapy, thereby avoiding excess costs and risk for bacterial resistance that result from broad-spectrum antibiotics. We also identified predictors of positivity that could increase suspicion for pneumococcal infection or avoid the unnecessary use of this test.
Authors: Shawna Bellew; Carlos G Grijalva; Derek J Williams; Evan J Anderson; Richard G Wunderink; Yuwei Zhu; Grant W Waterer; Anna M Bramley; Seema Jain; Kathryn M Edwards; Wesley H Self Journal: Clin Infect Dis Date: 2019-05-30 Impact factor: 9.079
Authors: Byunghyun Kim; Joonghee Kim; You Hwan Jo; Jae Hyuk Lee; Ji Eun Hwang; Min Ji Park; Sihyung Lee Journal: PLoS One Date: 2018-07-20 Impact factor: 3.240
Authors: Carlos M Luna; Laura Pulido; Michael S Niederman; Alberto Casey; Diego Burgos; Sebastián D Leiva Agüero; Alejandra Grosso; Evangelina Membriani; Andrea C Entrocassi; Marcelo Rodríquez Fermepin; Carlos A Vay; Susana Garcia; Angela Famiglietti Journal: Pneumonia (Nathan) Date: 2018-09-25