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Athlin S, Magnuson A, Spindler C, Hedlund J, Strålin K, Nauclér P. Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia: a register-based cohort study. J Infect 2022; 85:167-173. [PMID: 35618153 DOI: 10.1016/j.jinf.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 12/03/2021] [Accepted: 05/19/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the effect of pneumococcal urinary antigen test (UAT) usage on broad-spectrum antibiotic treatment in community-acquired pneumonia (CAP). METHODS Patients admitted to 32 Swedish hospitals between 2011-2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM). RESULTS UAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94-1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06-2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25-0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16-0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69-3.98) and 3-4 (OR 3.69, 95% CI 1.55-8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3-4 patients (OR 3.49, 95% CI 1.02-12.0). CONCLUSIONS Performing UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.
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Affiliation(s)
- Simon Athlin
- Department of Infectious Diseases, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Carl Spindler
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hedlund
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kristoffer Strålin
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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Ito A, Ishida T, Tachibana H, Nakanishi Y, Yamazaki A, Washio Y. Predictors and usefulness of targeted therapy for pneumococcal community-acquired pneumonia diagnosed by the urinary antigen test: a prospective, observational cohort study. Diagn Microbiol Infect Dis 2021; 101:115457. [PMID: 34271234 DOI: 10.1016/j.diagmicrobio.2021.115457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/24/2022]
Abstract
The aim of the present study was to investigate the predictors of targeted therapy (TT) for pneumococcal community-acquired pneumonia (PCAP) with a positive urinary antigen test (UAT) and compare the outcomes with those of nontargeted therapy. This prospective cohort study enrolled consecutive PCAP patients with a positive UAT who were hospitalized at Kurashiki Central Hospital from October 2010 to November 2019. A total of 286 patients were included. Of them, 56 patients (19.6%) were included in the TT group. On multivariate analysis, identification of Gram-positive diplococci by Gram stain (OR [95% CI]: 2.46 [1.32-4.63]) was a positive predictor, whereas aspiration pneumonia (0.17 [0.03-0.59]) and CURB-65 score (0.59 [0.42-0.81]) were negative predictors of TT. Initial treatment failure and 30-day mortality were not significantly different. The UAT is not used enough for TT, and TT for PCAP did not have worse outcomes.
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Key Words
- Community-acquired pneumonia
- pneumococcal pneumonia
- targeted therapy
- urinary antigen test. Abbreviations: Binax, Binax NOW S. pneumoniae urinary antigen test kit CAP, community-acquired pneumonia CURB-65, confusion, urea >7 mmol/L, respiratory rate ≥30 breaths per minute, low blood pressure (systolic <90 mm Hg or diastolic ≤60 mm Hg), and age ≥65 years IPTW, inverse probability of treatment weighting PSI, Pneumonia Severity Index PUAT, pneumococcal urinary antigen test UAT, urinary antigen test
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, Joyo, Kyoto, Japan
| | - Yosuke Nakanishi
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; Department of Respiratory Medicine, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan; Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Lee J, Song JU. Performance of pneumococcal urinary antigen test in patients with community-onset pneumonia: a propensity score-matching study. Korean J Intern Med 2020; 35:630-640. [PMID: 32088941 PMCID: PMC7214365 DOI: 10.3904/kjim.2018.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/08/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/AIMS Although pneumococcal urinary antigen tests (PUATs) have universally been used for the diagnosis of pneumococcal pneumonia, data on the efficacy of these exams are limited. The objective of our study was to investigate the clinical impact of the PUAT in patients with community-onset pneumonia (CO-pneumonia). METHODS We conducted a retrospective cohort study of patients diagnosed with CO-pneumonia. Patients were classified according to their PUAT results and were matched using the propensity score-matching method. The primary outcome was 30-day mortality. RESULTS A total of 1,257 patients were identified and 163 (13.0%) demonstrated positive PUAT results. The sensitivity and specificity values of PUAT for overall pneumococcal pneumonia were 56.5% and 91.4%, respectively. In the full cohort, there were no significant differences in 30-day mortality between the two groups (6.1% in the positive PUAT group vs. 8.2% in the negative PUAT group, p = 0.357). However, in the propensity-matched cohort, the 30-day mortality rates were lower in the positive PUAT group (5.6% vs. 17.4%, p = 0.001). With respect to secondary outcomes, the proportion of patients with potentially drug-resistant pathogens, changes in antibiotics, and failure rates of initial antibiotic therapy were significantly lower in the positive PUAT group than in the negative PUAT group of the propensity-matched cohort. CONCLUSION We found that the sensitivity of the index test was low and specificity was high in this clinical setting. And our findings suggest that positive PUAT results may be associated with favorable clinical outcomes in patients with CO-pneumonia.
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Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
- Correspondence to Jonghoo Lee, M.D. Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju 63241, Korea Tel: +82-64-717-1601 Fax: +82-64-717-1131 E-mail:
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim B, Kim J, Jo YH, Lee JH, Hwang JE, Park MJ, Lee S. Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia. PLoS One 2018; 13:e0200620. [PMID: 30028834 PMCID: PMC6054390 DOI: 10.1371/journal.pone.0200620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/29/2018] [Indexed: 12/18/2022] Open
Abstract
Background The pneumococcal urinary antigen test (UAT) has been known to improve sensitivity and specificity for the diagnosis of pneumococcal pneumonia. Associations of UAT results with prognosis in community acquired pneumonia (CAP) are not known. We hypothesized that positive UAT is associated with a good prognosis, and incorporation of UAT into CRB65 would improve its prognostic performance. Methods In this registry-based retrospective study, we analyzed CAP patients over a 10-year period beginning in April 2008. Patients who had UAT results were included in multivariable extended Cox-regression analyses to determine the association between UAT positivity and 30-day mortality. UAT results were incorporated for patients with a CRB65 score of 1 by subtracting 1 from the scoring system if the test was positive. The performance of the modified scoring systems was assessed with area under the receiver operating characteristic (AUROC) curves. Results Among 5145 CAP patients, total 2280 patients had UAT results and were included in analyses. A positive UAT result was associated with a good prognosis after a week of hospitalization (aHR, 0.14; p = 0.007). After modification of CRB65 using UAT results, positive and negative predictive values for 30-day mortality were increased from 7.7 to 8.3 (p<0.001) and 98.9 to 99.1 (p = 0.010). The AUROC increased from 0.73 to 0.75 (p<0.001). Conclusions Positive results on UAT could be considered as a good prognostic factor in CAP. UAT could be used as a useful tool in deciding whether to refer patients to the hospital, especially in moderate CAP with a CRB score of 1.
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Affiliation(s)
- Byunghyun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- * E-mail:
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Eun Hwang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Min Ji Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sihyung Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Komagamine J. The efficacy of high-dose penicillin G for pneumococcal pneumonia diagnosed based on initial comprehensive assessment at admission: an observational study. BMC Res Notes 2018; 11:399. [PMID: 29925417 PMCID: PMC6011604 DOI: 10.1186/s13104-018-3510-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives High-dose penicillin therapy is effective in approximately 90% of pneumococcal pneumonia cases diagnosed based on urinary pneumococcal antigen tests or Gram staining at admission. The efficacy of high-dose penicillin therapy for pneumococcal pneumonia diagnosed based on an initial comprehensive assessment comprising a syndromic approach, Gram staining of sputum and urinary pneumococcal antigen testing was investigated. Results Seventy adult patients diagnosed with pneumococcal pneumonia based on an initial comprehensive assessment and treated with high-dose penicillin G at admission were included. The median patient age was 76.5 years, and 37.1% of the patients were women. The urinary pneumococcal antigen test was positive in 67.1% of all patients, and Gram staining of sputum showed that gram-positive cocci were dominant in 58.6% of the patients. The primary outcome was treatment success based on vital signs until day 6. Treatment with high-dose penicillin G was effective in 87.1% of the patients (95% CI 79.1–95.2%), and the proportion of patients who received other antibiotics because of treatment failure with penicillin G was only 5.7%. The efficacy of high-dose penicillin G treatment for pneumococcal pneumonia diagnosed based on a comprehensive assessment at admission may be comparable to that in previous reports. Electronic supplementary material The online version of this article (10.1186/s13104-018-3510-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junpei Komagamine
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi, 3208580, Japan.
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The Alere BinaxNOW Pneumococcal Urinary Antigen Test: Diagnostic Sensitivity for Adult Pneumococcal Pneumonia and Relationship to Specific Serotypes. J Clin Microbiol 2018; 56:JCM.00787-17. [PMID: 29212700 DOI: 10.1128/jcm.00787-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/28/2017] [Indexed: 11/20/2022] Open
Abstract
Little is known about the sensitivity of the BinaxNOW pneumococcal urinary antigen (PUA) test for adult pneumococcal pneumonia caused by different serotypes. In this study, we aimed to analyze the trends in the sensitivity of the PUA test over a 15-year period (2001 to 2015) and to analyze its sensitivity for pneumococcal pneumonia caused by different serotypes. In total, we analyzed 1,096 pneumococcal isolates from adults with pneumococcal pneumonia who had a PUA test performed at the onset of the episode. Three periods were analyzed: 2001 to 2005 (early use of the seven-valent pneumococcal conjugate vaccine [early PCV7]), 2006 to 2010 (late PCV7), and 2011 to 2015 (early PCV13). The sensitivity of the PUA test varied from 76.4% (95% confidence interval [CI], 70.5% to 82.4%) in the period from 2001 to 2005 to 77.9% in 2006 to 2010 (95% CI, 74.4% to 81.4%) and decreased to 60.5% (95% CI, 55.4% to 65.6%) in 2011 to 2015. This decrease was observed in 560 proven (83.2% in 2001 to 2005, 86.5% in 2006 to 2010, and 78.1%) and 536 probable (70.0% in 2001 to 2005, 68.7% in 2006 to 2010, and 41.5% in 2011 to 2015) episodes of pneumococcal pneumonia. Differences were observed in the sensitivity of the PUA test for diagnosing pneumonia caused by certain serotypes, being highest for the 9V (90.6%), 14 (86.8%), 18C (100%), and 20 (100%) serotypes and lowest for the 8 (55.2%), 9L/N (39.1%), 11A (48.8%), 23B (33.3%), and nontypeable (47.8%) serotypes. Comparing 2001 to 2005, 2006 to 2010, and 2011 to 2015, the prevalence of serotypes 9V (3.1%, 3.7%, and 1.7%, respectively) and 14 (7.2%, 5.1%, and 3.1%, respectively) decreased, while the prevalence of serotypes 23B (0%, 0.7%, and 1.4%, respectively), 9L/N (1.0%, 1.6%, and 3.4%, respectively), 11A (2.6%, 4.2%, and 3.7%, respectively), and 8 (1.5%, 1.5%, and 5.1%, respectively) increased. The PUA test sensitivity varied by pneumococcal pneumonia serotype, and these differences and the changes in serotype distribution were associated with an overall decrease in the sensitivity of the PUA test.
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Comparison of the ImmuView and the BinaxNOW antigen tests in detection of Streptococcus pneumoniae and Legionella pneumophila in urine. Eur J Clin Microbiol Infect Dis 2017; 36:1933-1938. [PMID: 28589425 PMCID: PMC5602076 DOI: 10.1007/s10096-017-3016-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/12/2017] [Indexed: 02/07/2023]
Abstract
The use of urinary antigen tests (UATs) may provide early etiology in pneumonia, and facilitates rapid and directed antibiotic treatment. In this study, we evaluated the novel lateral flow ImmuView Streptococcus pneumoniae and Legionella pneumophila UAT, which detects pneumococcal and L. pneumophila serogroup 1 antigens in a combined test. We compared the ImmuView UAT with the BinaxNOW S. pneumoniae UAT and the BinaxNOW L. pneumophila UAT in 147 patients with pneumococcal bacteremia (n = 48), non-pneumococcal non-Legionella bacteremia (n = 93) and Legionella infections in the lower airways (L. pneumophila, n = 5; L. bozemanii, n = 1). In three cases, the ImmuView test was invalid before and after boiling while the BinaxNOW tests were valid in all cases. In 144 cases, the three UATs demonstrated a very good inter-assay agreement for detection of pneumococcal antigen (κ = 0.86) and L. pneumophila antigen (κ = 1.00). The ImmuView and BinaxNOW S. pneumoniae tests had similar sensitivities (62% vs 60%; p = ns) in 48 cases with pneumococcal bacteremia and both tests had specificities of 97% in 96 cases with non-pneumococcal infections. Furthermore, the ImmuView and BinaxNOW L. pneumophila tests were positive for Legionella antigen in five patients with confirmed L. pneumophila serogroup 1 infections, and negative in all non-L. pneumophila cases. The ImmuView and BinaxNOW tests performed similarly when evaluated on urine samples from bacteremic and non-bacteremic patients with identified etiology.
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Harris AM, Bramley AM, Jain S, Arnold SR, Ampofo K, Self WH, Williams DJ, Anderson EJ, Grijalva CG, McCullers JA, Pavia AT, Wunderink RG, Edwards KM, Winchell JM, Hicks LA. Influence of Antibiotics on the Detection of Bacteria by Culture-Based and Culture-Independent Diagnostic Tests in Patients Hospitalized With Community-Acquired Pneumonia. Open Forum Infect Dis 2017; 4:ofx014. [PMID: 28480285 DOI: 10.1093/ofid/ofx014] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/26/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Specimens collected after antibiotic exposure may reduce culture-based bacterial detections. The impact on culture-independent diagnostic tests is unclear. We assessed the effect of antibiotic exposure on both of these test results among patients hospitalized with community-acquired pneumonia (CAP). METHODS Culture-based bacterial testing included blood cultures and high-quality sputum or endotracheal tube (ET) aspirates; culture-independent testing included urinary antigen testing (adults) for Streptococcus pneumoniae and Legionella pneumophila and polymerase chain reaction (PCR) on nasopharyngeal and oropharyngeal (NP/OP) swabs for Mycoplasma pneumoniae and Chlamydia pneumoniae. The proportion of bacterial detections was compared between specimens collected before and after either any antibiotic exposure (prehospital and/or inpatient) or only prehospital antibiotics and increasing time after initiation of inpatient antibiotics. RESULTS Of 4678 CAP patients, 4383 (94%) received antibiotics: 3712 (85%) only inpatient, 642 (15%) both inpatient and prehospital, and 29 (<1%) only prehospital. There were more bacterial detections in specimens collected before antibiotics for blood cultures (5.2% vs 2.6%; P < .01) and sputum/ET cultures (50.0% vs 26.8%; P < .01) but not urine antigen (7.0% vs 5.7%; P = .53) or NP/OP PCR (6.7% vs 5.4%; P = .31). For all diagnostic testing, bacterial detections declined with increasing time between inpatient antibiotic administration and specimen collection. CONCLUSIONS Bacteria were less frequently detected in culture-based tests collected after antibiotics and in culture-independent tests that had longer intervals between antibiotic exposure and specimen collection. Bacterial yield could improve if specimens were collected promptly, preferably before antibiotics, providing data for improved antibiotic selection.
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Affiliation(s)
- Aaron M Harris
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Bramley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra R Arnold
- Le Bonheur Children's Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City
| | - Wesley H Self
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Jonathan A McCullers
- Le Bonheur Children's Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis.,St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center, Salt Lake City
| | | | | | | | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Mothes A, Léotard S, Nicolle I, Smets A, Chirio D, Rotomondo C, Tiger F, Del Giudice P, Perrin C, Néri D, Foucault C, Della Guardia M, Hyvernat H, Roger PM. Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy. Med Mal Infect 2016; 46:365-371. [DOI: 10.1016/j.medmal.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/28/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
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Zhou F, Gu L, Qu JX, Liu YM, Cao B. Evaluating the utility of Binax NOW Streptococcus pneumoniae urinary antigen test in adults with community acquired pneumonia in China. CLINICAL RESPIRATORY JOURNAL 2016; 12:425-432. [PMID: 27437639 DOI: 10.1111/crj.12533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/17/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Binax NOW rapid immunochromatographic membrane test (ICT), a rapid method for detection of Streptococcus pneumoniae antigen, has been used widely in Europe and America, but rarely in China. OBJECTIVE Our aim is to evaluate the utility of the ICT among adult patients with community acquired pneumonia (CAP) in China. METHODS Adult patients with CAP were prospectively recruited from 12 general hospitals. ICT tests were done in all patients and clinical data were recorded. Qualified sputum culture was used as the standard for determining the diagnostic usefulness of ICT test. RESULT Thousand hundred fifty four CAP patients were enrolled in analysis, with median (IQR) age of 48 (35) years. 276 (23.9%) patients had underling diseases, 770 (66.7%) had received antibiotics before ICT test. Overall, the positive rate of ICT test was 3.3%, with sensitivity and specificity 57.9% and 96.6%, respectively. Disease severity, chronic obstructive pulmonary disease (COPD), increased age; respiratory rate (RR), neutrophil ratio, blood urea nitrogen (BUN), procalcitonin (PCT) and the decreased oxygenation index were associated with positive results of ICT tests. Patients with BUN >7 mmol/L, CURB-65 3-5, PCT > 2ng/mL were the top three groups with highest positive rate of ICT test (22.6%, 22.2% and 21.1% respectively). CONCLUSION ICT test has a moderate sensitivity and high specificity in adults with CAP in China. Patients classified as sever pneumonia, or those with BUN > 7 mmol/L, or PCT > 2 ng/mL are more likely to have positive results.
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Affiliation(s)
- Fei Zhou
- Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.,Respiratory and Critical Care Medicine 2#, China-Japan Friendship Hospital, Beijing, China
| | - Li Gu
- Department of Infectious diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiu Xin Qu
- Department of Infectious diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Mei Liu
- Respiratory and Critical Care Medicine 2#, China-Japan Friendship Hospital, Beijing, China
| | - Bin Cao
- Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.,Respiratory and Critical Care Medicine 2#, China-Japan Friendship Hospital, Beijing, China
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Ciprero K, Zykov KA, Briko NI, Shekar T, Sterling TM, Bitieva E, Stek JE, Musey L. Safety and immunogenicity of a single dose 23-valent pneumococcal polysaccharide vaccine in Russian subjects. Hum Vaccin Immunother 2016; 12:2142-2147. [PMID: 27149114 DOI: 10.1080/21645515.2016.1165373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Pneumococcal infection is a major cause of pneumonia, bacteremia, and meningitis. Incidence of pneumococcal disease (PD) varies worldwide. The 23-valent pneumococcal polysaccharide vaccine (PPV23) displays an acceptable safety profile and has been demonstrated cost-effective in reducing burden of PD. METHODS Approximately 100 subjects from the Russian Federation who were either 2 to 49 y of age with increased risk for PD or ≥50 years of age were enrolled into the study (NCT01734239) to receive a single dose of PPV23 administered intramuscularly. Each subject was followed for local and systemic adverse events (AEs) for 5 and 14 days, respectively. Serious AEs were collected for 28 d postvaccination. Blood samples were collected immediately prior to vaccination and 28 d postvaccination for the measurement of IgG to serotypes 1, 6B, 14, 19F, and 23F. RESULTS High proportion of subjects had ≥2 -fold increase in IgG following receipt of PPV23. Rates were 92.0%, 83.0%, 89.0%, 81%, 84% for serotypes 1, 6B, 14, 19F, and 23F, respectively. Similar rates of responders and increases in the magnitude of immune responses were observed in both age groups (2-49, ≥50 ). PPV23 was generally safe and well tolerated. Injection site and systemic AEs were reported by 14.7% and 18.6% of study subjects, respectively. CONCLUSIONS PPV23 is generally safe, well tolerated, and highly immunogenic when given as a single dose to Russian individuals 50 y of age and older, as well as Russian individuals 2 to 49 y of age who are at high risk for PD.
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Affiliation(s)
| | - Kirill A Zykov
- b Moscow State University of Medicine and Dentistry , Moscow , Russian Federation
| | - Nikolay I Briko
- c I.M. Sechenov First Moscow State Medical University , Moscow , Russian Federation
| | | | | | - Elizaveta Bitieva
- d Merck Sharp & Dohme (MSD) Pharmaceuticals LLC , Moscow , Russian Federation
| | - Jon E Stek
- a Merck & Co., Inc. , Kenilworth , NJ , USA
| | - Luwy Musey
- a Merck & Co., Inc. , Kenilworth , NJ , USA
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Severe community-acquired pneumonia and positive urinary antigen test for S. pneumoniae: amoxicillin is associated with a favourable outcome. Eur J Clin Microbiol Infect Dis 2015; 34:2455-61. [DOI: 10.1007/s10096-015-2503-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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Dirou S, Cazanave C. [Urine antigen testing: Indication and contribution to the treatment of community-acquired pneumonia]. Rev Mal Respir 2015. [PMID: 26204800 DOI: 10.1016/j.rmr.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Urinary antigen tests are quick and simple tests helping to provide an etiological diagnosis in community-acquired pneumonia. However, their prescription is sometimes excessive and performed in unjustified situations. The therapeutic benefit is limited. Indeed, studies show that appropriate antibiotic therapy based on the result of urinary antigen tests does not improve the cost and the patient survival compared to empirical antibiotic therapy. One must be careful before antibiotic therapy reduction based on the sole negative result of urinary antigen test. Legionella urinary antigen test is the most commonly method used for the diagnosis of legionellosis but must be prescribed in a specific clinical context. Streptococcus pneumoniae urinary antigen test is especially interesting in the epidemiological surveillance of pneumococcal community-acquired pneumonia.
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Affiliation(s)
- S Dirou
- Service de pneumologie, l'institut du thorax, hôpital G.- et R.- Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France.
| | - C Cazanave
- Service de maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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15
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Fukushima K, Nakamura S, Inoue Y, Higashiyama Y, Ohmichi M, Ishida T, Yoshimura K, Sawai T, Takayanagi N, Nakahama C, Kakugawa T, Izumikawa K, Aoki N, Nishioka Y, Kosaka O, Kohno S. Utility of a Sputum Antigen Detection Test in Pneumococcal Pneumonia and Lower Respiratory Infectious Disease in Adults. Intern Med 2015; 54:2843-50. [PMID: 26567996 DOI: 10.2169/internalmedicine.54.4082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare the utility of Gram staining, a urinary antigen detection kit and a sputum antigen detection kit were examined for the rapid and early detection of pneumococcal pneumonia and lower respiratory infectious diseases. METHODS A newly developed sputum pneumococcal antigen detection kit (RAPIRUN), Gram staining, and urinary antigen detection kit (BinaxNOW) were comparatively evaluated for their ability to detect Streptococcus pneumoniae in patients with pneumonia or lower respiratory tract infection. Sputum culture results were used as a standard for comparison. Furthermore, the pneumococcus-positive rates in culture and rapid tests were compared using polymerase chain reaction (PCR) as a reference. RESULTS Of the 169 patients studied, 54 (32.0%) tested positive for S. pneumoniae in culture. S. pneumoniae detection sensitivities for Gram staining, RAPIRUN, and BinaxNOW were 75.9%, 90.7%, and 53.7%, respectively; thus, RAPIRUN had a significantly higher sensitivity than BinaxNOW (p<0.001). For patients with ≥10(5) copies/μg of pneumococcal surface protein A DNA PCR analysis, the detection rates of culture, Gram staining, and RAPIRUN were 85.2%, 72.1%, and 82.0%, respectively, however, the detection rate of BinaxNOW was only 47.5%. Comparisons among 45 patients with culture-positive pneumococcal pneumonia revealed that RAPIRUN had a significantly higher detection rate than BinaxNOW in the mild cases (p<0.006), regardless of the number of days from onset (p<0.03). CONCLUSION RAPIRUN is a rapid testing kit that detects S. pneumoniae in sputum with a high sensitivity and specificity. It is a particularly more useful detection kit than BinaxNOW for early and mild community-acquired pneumonia in pre-treatment patients whose sputum specimens can be obtained.
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Affiliation(s)
- Kiyoyasu Fukushima
- Department of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Japan
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16
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Huijts SM, Boersma WG, Grobbee DE, Gruber WC, Jansen KU, Kluytmans JAJW, Kuipers BAF, Palmen F, Pride MW, Webber C, Bonten MJM. Predicting pneumococcal community-acquired pneumonia in the emergency department: evaluation of clinical parameters. Clin Microbiol Infect 2014; 20:1316-22. [PMID: 24975428 DOI: 10.1111/1469-0691.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to quantify the value of clinical predictors available in the emergency department (ED) in predicting Streptococcus pneumoniae as the cause of community-acquired pneumonia (CAP). A prospective, observational, cohort study of patients with CAP presenting in the ED was performed. Pneumococcal aetiology of CAP was based on either bacteraemia, or S. pneumoniae being cultured from sputum, or urinary immunochromatographic assay positivity, or positivity of a novel serotype-specific urinary antigen detection test. Multivariate logistic regression was used to identify independent predictors and various cut-off values of probability scores were used to evaluate the usefulness of the model. Three hundred and twenty-eight (31.0%) of 1057 patients with CAP had pneumococcal CAP. Nine independent predictors for pneumococcal pneumonia were identified, but the clinical utility of this prediction model was disappointing, because of low positive predictive values or a small yield. Clinical criteria have insufficient diagnostic capacity to predict pneumococcal CAP. Rapid antigen detection tests are needed to diagnose S. pneumoniae at the time of hospital admission.
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Affiliation(s)
- S M Huijts
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, USA
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Suryam V, Bhatti VK, Kulkarni A, Mahen A, Nair V. Outbreak control of community acquired pneumonia in a large military training institution. Med J Armed Forces India 2014; 71:33-7. [PMID: 25609861 DOI: 10.1016/j.mjafi.2014.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Between 09 Jan 2011 to 25 Mar 2011 an outbreak of respiratory illness was reported from a Military Training institution. 52 cases of respiratory tract infection were admitted from this institution. All the cases were trainees between 18 and 21 years of age. Aggressive control measures were instituted along with the investigation of the outbreak to determine the nature of the disease and the causative organism. METHODS The investigation of the outbreak was initiated on 08 Mar 2011 when a sudden rise in number of hospital admissions due to respiratory illness was noticed. Epidemiological information was collected from the cases. Routine blood investigations, sputum examination and chest radiograph of suspected cases were done. RESULTS Total of 52 cases of respiratory illness were reported during the period of outbreak giving an attack rate of 25.8 per 1000. Out of these 52 cases 23 (44.2%) were radiologically confirmed. Streptococcus pneumoniae was grown in 8 (25.85) out of 31 sputum samples. The outbreak was controlled by administration of 'supervised mass chemoprophylaxis' of all susceptible individuals in the institution with Tablet Azithromycin orally. Last suspected case was admitted to the military hospital on 25 Mar 2011. CONCLUSION The study highlights the importance of Streptococcus pneumoniae as a causative organism for outbreaks of community acquired pneumonia (CAP) in large residential training institutions and reiterates the need for formulating a policy for continuous surveillance. It also highlights the importance of the novel method of using chemoprophylaxis for control of an ongoing outbreak of CAP.
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Affiliation(s)
- Vani Suryam
- Associate Professor, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - V K Bhatti
- Colonel (Health), HQ Northern Command, C/O 56 APO, India
| | | | - A Mahen
- Dy PMO, HQ Western Air Command, C/O 56 APO, India
| | - Velu Nair
- Senior Consultant (Med), O/O DGAFMS, Ministry of Defence, M Block, New Delhi 110001, India
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Harris AM, Beekmann SE, Polgreen PM, Moore MR. Rapid urine antigen testing for Streptococcus pneumoniae in adults with community-acquired pneumonia: clinical use and barriers. Diagn Microbiol Infect Dis 2014; 79:454-7. [PMID: 24938760 DOI: 10.1016/j.diagmicrobio.2014.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
Streptococcus pneumoniae (pneumococcus) is the most common bacterial etiology of community-acquired pneumonia (CAP) in adults, a leading cause of death. The majority of pneumococcal CAP is diagnosed by blood culture, which likely underestimates the burden of disease. The 2007 CAP guidelines recommend routine use of the rapid pneumococcal urinary antigen (UAg) test. To assess the how pneumococcal UAg testing is being used among hospitalized adult CAP patients and what barriers restrict its use, a Web-based survey was distributed in 2013 to 1287 infectious disease physician members of the Emerging Infectious disease Network of the Infectious Disease Society of America. Of 493 eligible responses, 65% use the pneumococcal UAg test. The primary barrier to UAg use was availability (46%). UAg users reported ordering fewer other diagnostic tests and tailoring antibiotic therapy. Increased access to UAg tests could improve pneumonia management and pneumococcal CAP surveillance.
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Affiliation(s)
- Aaron M Harris
- Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | | | - Matthew R Moore
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Urine antigen tests for the diagnosis of respiratory infections: legionellosis, histoplasmosis, pneumococcal pneumonia. Clin Lab Med 2014; 34:219-36. [PMID: 24856525 DOI: 10.1016/j.cll.2014.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Urinary antigen testing has grown in popularity for several significant respiratory infections, particularly Legionella pneumophila, Streptococcus pneumoniae, and Histoplasma capsulatum. By capitalizing on the concentration of shed antigen from a variety of pathogens in the kidneys for excretion in the urine, urinary antigen testing can be used to obtain rapid test results related to respiratory infection, independent of an invasive collection such as a bronchoalveolar lavage. This article describes the 3 aforementioned organisms, their role in respiratory disease, and the current status of urinary antigen testing in their respective diagnosis.
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20
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Chico RM, Hack BB, Newport MJ, Ngulube E, Chandramohan D. On the pathway to better birth outcomes? A systematic review of azithromycin and curable sexually transmitted infections. Expert Rev Anti Infect Ther 2013; 11:1303-32. [PMID: 24191955 PMCID: PMC3906303 DOI: 10.1586/14787210.2013.851601] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The WHO recommends the administration of sulfadoxine-pyrimethamine (SP) to all pregnant women living in areas of moderate (stable) to high malaria transmission during scheduled antenatal visits, beginning in the second trimester and continuing to delivery. Malaria parasites have lost sensitivity to SP in many endemic areas, prompting the investigation of alternatives that include azithromycin-based combination (ABC) therapies. Use of ABC therapies may also confer protection against curable sexually transmitted infections and reproductive tract infections (STIs/RTIs). The magnitude of protection at the population level would depend on the efficacy of the azithromycin-based regimen used and the underlying prevalence of curable STIs/RTIs among pregnant women who receive preventive treatment. This systematic review summarizes the efficacy data of azithromycin against curable STIs/RTIs.
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Affiliation(s)
- R Matthew Chico
- London School of Hygiene and Tropical Medicine Keppel Street, London, WC1E 7HT,UK
| | - Berkin B Hack
- Brighton and Sussex Medical School,Brighton, East Sussex, BN1 9PX,UK
| | - Melanie J Newport
- Brighton and Sussex Medical School,Brighton, East Sussex, BN1 9PX,UK
| | - Enesia Ngulube
- London School of Hygiene and Tropical Medicine Keppel Street, London, WC1E 7HT,UK
| | - Daniel Chandramohan
- London School of Hygiene and Tropical Medicine Keppel Street, London, WC1E 7HT,UK
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21
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Comparison of sputum and nasopharyngeal aspirate samples and of the PCR gene targets lytA and Spn9802 for quantitative PCR for rapid detection of pneumococcal pneumonia. J Clin Microbiol 2013; 52:83-9. [PMID: 24153121 DOI: 10.1128/jcm.01742-13] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We aimed to compare sputum and nasopharyngeal aspirate (NpA) samples and the PCR gene targets lytA and Spn9802 in quantitative PCR (qPCR) assays for rapid detection of pneumococcal etiology in community-acquired pneumonia (CAP). Seventy-eight adult patients hospitalized for radiologically confirmed CAP had both good-quality sputum and NpA specimens collected at admission. These samples were subjected to lytA qPCR and Spn9802 qPCR assays with analytical times of <3 h. Thirty-two patients had CAP with a pneumococcal etiology, according to conventional diagnostic criteria. The following qPCR positivity rates were noted in CAP cases with and without pneumococcal etiology: 96% and 15% (sputum lytA assay), 96% and 17% (sputum Spn9802 assay), 81% and 11% (NpA lytA assay), and 81% and 20% (NpA Spn9802 assay), respectively. The mean lytA and Spn9802 DNA levels were significantly higher in qPCR-positive sputum samples from cases with pneumococcal etiology than in qPCR-positive sputum samples from CAP cases without pneumococcal etiology or qPCR-positive NpA samples from cases with pneumococcal etiology (P < 0.02 for all comparisons). For detection of pneumococcal etiology, receiver operating characteristic curve analysis showed that sputum specimens were superior to NpA specimens as the sample type (P < 0.02 for both gene targets) and lytA tended to be superior to Spn9802 as the gene target. The best-performing test, the sputum lytA qPCR assay, showed high sensitivity (94%) and specificity (96%) with a cutoff value of 10(5) DNA copies/ml. In CAP patients with good sputum production, this test has great potential to be used for the rapid detection of pneumococcal etiology and to target penicillin therapy.
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22
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Said MA, Johnson HL, Nonyane BAS, Deloria-Knoll M, O'Brien KL, Andreo F, Beovic B, Blanco S, Boersma WG, Boulware DR, Butler JC, Carratalà J, Chang FY, Charles PGP, Diaz AA, Domínguez J, Ehara N, Endeman H, Falcó V, Falguera M, Fukushima K, Garcia-Vidal C, Genne D, Guchev IA, Gutierrez F, Hernes SS, Hoepelman AIM, Hohenthal U, Johansson N, Kolek V, Kozlov RS, Lauderdale TL, Mareković I, Masiá M, Matta MA, Miró Ò, Murdoch DR, Nuermberger E, Paolini R, Perelló R, Snijders D, Plečko V, Sordé R, Strålin K, van der Eerden MM, Vila-Corcoles A, Watt JP. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One 2013; 8:e60273. [PMID: 23565216 PMCID: PMC3615022 DOI: 10.1371/journal.pone.0060273] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 02/26/2013] [Indexed: 12/17/2022] Open
Abstract
Background Pneumococcal pneumonia causes significant morbidity and mortality among adults. Given limitations of diagnostic tests for non-bacteremic pneumococcal pneumonia, most studies report the incidence of bacteremic or invasive pneumococcal disease (IPD), and thus, grossly underestimate the pneumococcal pneumonia burden. We aimed to develop a conceptual and quantitative strategy to estimate the non-bacteremic disease burden among adults with community-acquired pneumonia (CAP) using systematic study methods and the availability of a urine antigen assay. Methods and Findings We performed a systematic literature review of studies providing information on the relative yield of various diagnostic assays (BinaxNOW® S. pneumoniae urine antigen test (UAT) with blood and/or sputum culture) in diagnosing pneumococcal pneumonia. We estimated the proportion of pneumococcal pneumonia that is bacteremic, the proportion of CAP attributable to pneumococcus, and the additional contribution of the Binax UAT beyond conventional diagnostic techniques, using random effects meta-analytic methods and bootstrapping. We included 35 studies in the analysis, predominantly from developed countries. The estimated proportion of pneumococcal pneumonia that is bacteremic was 24.8% (95% CI: 21.3%, 28.9%). The estimated proportion of CAP attributable to pneumococcus was 27.3% (95% CI: 23.9%, 31.1%). The Binax UAT diagnosed an additional 11.4% (95% CI: 9.6, 13.6%) of CAP beyond conventional techniques. We were limited by the fact that not all patients underwent all diagnostic tests and by the sensitivity and specificity of the diagnostic tests themselves. We address these resulting biases and provide a range of plausible values in order to estimate the burden of pneumococcal pneumonia among adults. Conclusions Estimating the adult burden of pneumococcal disease from bacteremic pneumococcal pneumonia data alone significantly underestimates the true burden of disease in adults. For every case of bacteremic pneumococcal pneumonia, we estimate that there are at least 3 additional cases of non-bacteremic pneumococcal pneumonia.
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Affiliation(s)
- Maria A Said
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
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Athlin S, Strålin K. The Binax NOW Streptococcus pneumoniae test applied on nasopharyngeal aspirates to support pneumococcal aetiology in community-acquired pneumonia. ACTA ACUST UNITED AC 2013; 45:425-31. [PMID: 23330980 DOI: 10.3109/00365548.2012.760843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The use of nasopharyngeal secretions to enhance diagnostic yields of pneumococcal aetiology in community-acquired pneumonia (CAP) is of interest. We evaluated the Binax NOW Streptococcus pneumoniae immunochromatographic test (ICT) on nasopharyngeal aspirates (NPA) in order to support pneumococcal aetiology in CAP. METHODS The NPA ICT was applied on 180 adult CAP patients and 64 healthy controls. The rate of pneumococcal detection in the nasopharynx was compared to rates for lytA polymerase chain reaction (PCR) and culture on NPA. RESULTS According to blood and sputum culture and urine ICT, the test sensitivity in 59 patients with a pneumococcal aetiology was 81%. The specificity was suboptimal, with 72% negative tests among CAP patients without a pneumococcal aetiology. However, the test was positive in only 11% of patients with atypical pneumonia and in 4.7% of healthy controls. The positivity rate was higher for NPA ICT compared to culture on NPA in all CAP patients, and to both PCR and culture on NPA in non-pneumococcal non-atypical CAP patients. In 113 (63%) patients with β-lactam monotherapy, cure without treatment alteration was noted more often in cases with positive compared to negative NPA ICT at admission (91% vs 69%; p < 0.01). CONCLUSIONS The high sensitivity and the low positivity rates in patients with atypical pneumonia and healthy controls, in combination with the correlation between positive test results and clinical cure with β-lactam therapy, may support a pneumococcal aetiology in CAP in populations with low pneumococcal carriage rates.
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Affiliation(s)
- Simon Athlin
- Department of Infectious Diseases , Örebro University Hospital, Örebro, Sweden.
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24
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Abstract
We evaluated the usefulness of a rapid immunochromatographic pneumococcal urinary antigen test (UAT) for the diagnosis of pneumonia over a period of five years. The UAT was positive in 32 (2.3%) urine samples obtained from 1414 patients. In 46 of these 1414 patients results of UAT and/or sputum/pleural fluid culture and/or blood culture and/or procalcitonin levels were available and therefore the study was concentrated on these patients. A concordance between UAT positivity and the presence of Streptococcus pneumoniae in the sputum was observed in only 4 of 46 (8.7%) patients for which both urine and sputum samples were analyzed. A discordant result (UAT positive and absence of S. pneumoniae in sputum samples) was recorded in 8 of 46 (17.4 %) patients. UAT negative results with sputum culture positive for S. pneumoniae were recorded in 28.3% of patients. In 20 patients, UAT tested positive but sputum culture was not performed. A concordance between UAT positivity and the isolation of S. pneumoniae from blood was seen in 2 of 46 patients whereas a discordant result (UAT positive and blood culture negative) was seen in 12 (26.1%) patients. A concordance between the UAT and high levels (≥2ng/ml) of procalcitonin was observed in 4 out of 46 patients, whereas a positive UAT result and a procalcitonin negative result were observed in 2 patients. In our experience the UAT allows the detection of the etiological agent of pneumonia, and also when sputum and/or blood cultures are negative for S. pneumoniae, when the clinical picture is suggestive of alveolar pneumonia.
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Affiliation(s)
- Thomas M File
- Infectious Disease Section, Internal Medicine Department, Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, OH 44272, USA.
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Vernet G, Saha S, Satzke C, Burgess D, Alderson M, Maisonneuve JF, Beall B, Steinhoff M, Klugman K. Laboratory-based diagnosis of pneumococcal pneumonia: state of the art and unmet needs. Clin Microbiol Infect 2011; 17 Suppl 3:1-13. [DOI: 10.1111/j.1469-0691.2011.03496.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Klugman KP, Madhi SA, Albrich WC. Novel approaches to the identification of Streptococcus pneumoniae as the cause of community-acquired pneumonia. Clin Infect Dis 2008; 47 Suppl 3:S202-6. [PMID: 18986290 DOI: 10.1086/591405] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Current diagnostic tests lack sensitivity for the identification of the bacterial etiology of pneumonia. Attempts during the past 2 decades to improve sensitivity of detection of bacterial constituents in blood by use of antibody-antigen complexes and polymerase chain reaction have been disappointing. Recent data using pneumococcal conjugate vaccines as probes suggest that increased levels of both C-reactive protein and procalcitonin may be useful adjuncts to chest radiographs in the selection of patients with presumed bacterial pneumonia for inclusion in clinical trials. Among pneumococcal diagnostics currently under investigation, quantitative real-time polymerase chain reaction of respiratory secretions, as well as urinary antigen detection and pneumococcal surface adhesin A serological analysis for adults, are candidates for use in future clinical trials of antibiotics.
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Affiliation(s)
- Keith P Klugman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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28
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Falguera M. Pharmacotherapy of pneumonia occurring in older patients. Expert Opin Pharmacother 2008; 9:2867-79. [DOI: 10.1517/14656566.9.16.2867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Werno AM, Murdoch DR. Medical microbiology: laboratory diagnosis of invasive pneumococcal disease. Clin Infect Dis 2008; 46:926-32. [PMID: 18260752 DOI: 10.1086/528798] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The laboratory diagnosis of invasive pneumococcal disease (IPD) continues to rely on culture-based methods that have been used for many decades. The most significant recent developments have occurred with antigen detection assays, whereas the role of nucleic acid amplification tests has yet to be fully clarified. Despite developments in laboratory diagnostics, a microbiological diagnosis is still not made in most cases of IPD, particularly for pneumococcal pneumonia. The limitations of existing diagnostic tests impact the ability to obtain accurate IPD burden data and to assess the effectiveness of control measures, such as vaccination, in addition to the ability to diagnose IPD in individual patients. There is an urgent need for improved diagnostic tests for pneumococcal disease--especially tests that are suitable for use in underresourced countries.
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Affiliation(s)
- Anja M Werno
- Department of Microbiology, Canterbury Health Laboratories, University of Otago, Christchurch, New Zealand
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Strålin K. Usefulness of aetiological tests for guiding antibiotic therapy in community-acquired pneumonia. Int J Antimicrob Agents 2008; 31:3-11. [DOI: 10.1016/j.ijantimicag.2007.06.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 06/26/2007] [Indexed: 11/30/2022]
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Boulware DR, Daley CL, Merrifield C, Hopewell PC, Janoff EN. Rapid diagnosis of pneumococcal pneumonia among HIV-infected adults with urine antigen detection. J Infect 2007; 55:300-9. [PMID: 17692384 PMCID: PMC2039755 DOI: 10.1016/j.jinf.2007.06.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 06/25/2007] [Accepted: 06/25/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Streptococcus pneumoniae is the leading cause of bacterial pneumonia and associated bacteremia during HIV infection. Rapid diagnostic assays may limit inappropriate therapy. METHODS Clinical signs and symptoms and sera and urine were collected prospectively from 70 adults with pneumococcal pneumonia, including 47 with HIV co-infection. Pneumococcal C-polysaccharide antigen was detected in urine using the Binax immunochromatographic test (ICT). A systematic review of 24 published studies was conducted. RESULTS Clinical symptoms, signs, and laboratory parameters except leukocytosis, were similar in HIV-infected and HIV-seronegative pneumonia. The performance of the urine antigen ICT was independent of HIV-status (sensitivity 81%, specificity 98%, positive (PPV) and negative predictive values (NPV) 98%, and 82%, respectively). The sensitivity of sputum Gram's stain was 58% (34/59) with sputum unable to be provided by 16%. The CRP response was identical in HIV-infected (mean+/-SD) 133+/-88 vs. seronegative 135+/-104 mg/L (p=0.9). In the systematic review, the ICT performance revealed 74% sensitivity (95% CI 72-77%) and 94% specificity (95% CI 93-95%). Urine antigen testing increases etiologic diagnosis by 23% (range: 10-59%) when testing adults with community acquired pneumonia of unknown etiology. CONCLUSIONS Urinary antigen detection provides a credible rapid diagnostic test for pneumococcal pneumonia regardless of HIV-status. CRP response to acute infection is similar in HIV co-infection and increases diagnostic certainty.
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Affiliation(s)
- David R Boulware
- Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, MMC 250, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
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Diederen BMW, Peeters MF. Rapid diagnosis of pneumococcal pneumonia in adults using the Binax NOW Streptococcus pneumoniae urinary antigen test. Int J Infect Dis 2007; 11:284-5. [PMID: 17236801 DOI: 10.1016/j.ijid.2006.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 07/05/2006] [Accepted: 07/08/2006] [Indexed: 11/26/2022] Open
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Vidal J, Adrover A, García-Méndez E, García-Rey C, Dal-Ré R. Lack of usefulness of the immunochromatographic urinary pneumococcal antigen test in maximizing pneumococcal yield in a community-acquired pneumonia clinical trial. J Chemother 2007; 18:562-4. [PMID: 17127237 DOI: 10.1179/joc.2006.18.5.562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
PURPOSE OF REVIEW Streptococcus pneumoniae is the leading cause of community-acquired pneumonia worldwide and is the most likely causative pathogen in patients with community-acquired pneumonia admitted to the intensive care unit. Bacteremic pneumococcal pneumonia is an advanced stage of severe pneumococcal pneumonia. Improvement in the management of bacteremic pneumococcal pneumonia has the potential for improving the survival for severe pneumococcal pneumonia. RECENT FINDINGS Non-culture methods, especially the Binax urinary antigen test, can increase the diagnostic yield for pneumococcal pneumonia, allowing targeted antimicrobial therapy (specifically penicillin). In-vitro resistance to penicillin has increased over the past decade; however, it has not led to clinical failure when used for pneumococcal pneumonia. SUMMARY Hospitalized patients with community-acquired pneumonia should have blood cultures obtained to confirm the possibility of bacteremic pneumococcal pneumonia. Based on pharmacodynamic properties, parenteral penicillin remains the drug of choice to treat pneumococcal pneumonia regardless of in-vitro resistance. Combination antimicrobial therapy will likely improve survival of patients with bacteremic pneumococcal pneumonia among the subset of critically ill patients.
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Affiliation(s)
- Christine C C Chiou
- Department of Pediatrics, Veterans General Hospital - Kaohsiung, Kaohsiung, Taiwan
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Briones ML, Blanquer J, Ferrando D, Blasco ML, Gimeno C, Marín J. Assessment of analysis of urinary pneumococcal antigen by immunochromatography for etiologic diagnosis of community-acquired pneumonia in adults. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2006; 13:1092-7. [PMID: 17028212 PMCID: PMC1595326 DOI: 10.1128/cvi.00090-06] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 05/23/2006] [Accepted: 07/26/2006] [Indexed: 11/20/2022]
Abstract
The limitations of conventional microbiologic methods (CMM) for etiologic diagnosis of community pneumococcal pneumonia have made faster diagnostic techniques necessary. Our aim was to evaluate the usefulness of the immunochromatography (ICT) technique for detecting urinary Streptococcus pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP). This was a prospective study on in-patients with CAP in a tertiary hospital conducted from October 2000 to March 2004. Apart from using CMM to reach an etiologic diagnosis, we determined pneumococcal antigen in concentrated urine by ICT. We also determined the urinary pneumococcal antigen (UPA) content in patients from two control groups to calculate the specificity of the technique. One group was comprised of in-patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma, with respiratory infection, and without pneumonia; the other group included fractures. We studied 959 pneumonia patients and determined UPA content in 911 (95%) of them. We diagnosed the etiology of 253 cases (28%) using CMM; S. pneumoniae was the most common etiologic agent (57 cases). ICT analysis was positive for 279 patients (31%). Using this technique, the percentage of diagnoses of pneumococcal pneumonias increased by 26%, while the overall etiologic diagnosis increased from 28 to 49%. The technique sensitivity was 81%; the specificity oscillated between 80% in CAP with nonpneumococcal etiology and 99% for patients with fractures without infections. Determination of UPA is a rapid, simple analysis with good sensitivity and specificity, which increased the percentage of etiologic diagnoses. Positive UPA may persist in COPD patients with probable pneumococcal colonization or recent pneumococcal infections.
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Affiliation(s)
- Maria Luisa Briones
- Pneumology Department, Respiratory Intensive Care Unit, Hospital Clínico Universitario, Universitat de Valencia, Spain.
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Abstract
Lower respiratory tract infection is easily suggested on clinical signs (cough and sputum) associated with fever. To discriminate between pneumonia and acute bronchitis is crucial because of the mortality associated with pneumonia and of its specific management. Chest X-ray is a key exam for the diagnosis and should be performed on the basis of validated clinical signs that are however of weak diagnostic value. Clinical as well as radiological signs cannot be reliably used to identify the causative germ. Sputum examination, the search for pneumococcal and legionella urinary antigens are of good diagnostic value. An associated COPD may lead to an acute respiratory failure. Acute exacerbation of chronic bronchitis results from various causes but infection is involved in about 50% of the cases, mostly viral and most often due to a rhinovirus. Viral infection can be associated to bacterial infection and the most frequently isolated germs are Streptococcus pneumoniae, Haemophilus influenzae, and B. catarrhalis. Severity assessment relies on the value of basal FEV1 that is often non available. Therefore Afssaps suggests using a dyspnea index to assess exacerbation severity.
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Affiliation(s)
- B Housset
- Service de pneumologie et pathologie professionnelle, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Peterson LR. Penicillins for Treatment of Pneumococcal Pneumonia: Does In Vitro Resistance Really Matter? Clin Infect Dis 2006; 42:224-33. [PMID: 16355333 DOI: 10.1086/497594] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2004] [Accepted: 08/02/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The rate of in vitro bacterial resistance to antimicrobial agents is escalating among pathogens that cause the most serious respiratory tract infections. Many reports published during the past few years suggest that this has direct clinical implications. In particular, resistance of Streptococcus pneumoniae to beta-lactam antibiotic therapy has assumed a prominent role in the evolution of guidelines for the initial treatment of respiratory tract infection. METHODS I conducted a critical review of the published medical literature. RESULTS There is only a single report of documented microbiologic failure of parenteral penicillin-class antibiotics in the treatment of pneumococcal pneumonia in patients with or without bacteremia, whereas there are numerous well-documented reports of treatment failure with quinolone-class (n > or = 21) and macrolide-class (n > or = 33) antibiotics in the treatment of pneumococcal pneumonia. CONCLUSION The recommended optimal in-hospital therapy for community-acquired pneumonia should continue to be a beta-lactam antibiotic (penicillin, aminopenicillin, cefotaxime, or ceftriaxone) administered with a macrolide or a fluoroquinolone agent for adjunctive treatment of infection with potential atypical pathogens.
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Affiliation(s)
- Lance R Peterson
- Evanston Northwestern Healthcare Research Institute, Division of Microbiology, Department of Pathology and Laboratory Medicine, Northwestern University, Evanston, IL, USA.
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File T, Kozlov R. Rapid detection of Streptococcus pneumoniae in community-acquired pneumonia. Clin Microbiol Infect 2006. [DOI: 10.1111/j.1469-0691.2006.01653.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yu VL, Klugman KP, Wagener MM, Chiou CC, Baddour LM. Is Combination the Only Issue? Am J Respir Crit Care Med 2005. [DOI: 10.1164/ajrccm.172.11.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Community Acquired Pneumonia (CAP) is the most important infectious disease in Germany. In the acute phase, lethality is almost 10%, and in the six months follow up period following the acute infection, lethality is more than 15%. Problems with resistances had not been found in Germany, except for a decreasing susceptibility of S. pneumoniae against macrolides. The CRB-65 score allows a reliable discrimination between patients with a high and low risk of dying. The new S3 guideline for diagnosis and treatment of community acquired pneumonia recommends a risk adapted treatment. Low risk patients shall receive a monotherapy with e. g. amoxicillin, high risk patients should be treated with a broad spectrum combination therapy (beta-lactam and macrolide).
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Affiliation(s)
- T Welte
- Abteilung Pneumologie, Medizinische Hochschule Hannover
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Strålin K, Holmberg H. Usefulness of the Streptococcus pneumoniae Urinary Antigen Test in the Treatment of Community-Acquired Pneumonia. Clin Infect Dis 2005; 41:1209-10. [PMID: 16163644 DOI: 10.1086/444566] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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