1
|
Marimuthu S, Damiano RB, Wolf LA. Performance Characteristics of a Real-Time PCR Assay for Direct Detection of Streptococcus pneumoniae in Clinical Specimens. J Mol Diagn 2024; 26:552-562. [PMID: 38677549 DOI: 10.1016/j.jmoldx.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/19/2024] [Accepted: 03/13/2024] [Indexed: 04/29/2024] Open
Abstract
Community-acquired pneumonia and complications, such as bacteremia and meningitis due to Streptococcus pneumoniae infection, still occur in at-risk populations, despite the availability of effective vaccines. Laboratory confirmation of S. pneumoniae remains challenging despite advances in blood culture techniques and the availability of nucleic acid-amplification tests. The goal of this study was to determine the performance characteristics of a molecular assay designed as a diagnostic test using primary clinical specimens for invasive pneumococcal disease. The molecular assay adapted for the Luminex Aries instrument targets an S. pneumoniae-specific gene (autolysin, lytA) in clinical specimens. Using real-time PCR MultiCode technology, four different clinical specimen types were evaluated. Specimen types included bronchoalveolar lavage, whole blood, cerebrospinal fluid, and urine to cover the various presentations and appropriate specimen types for invasive pneumococcal infections. The lower limit of detection in urine was 10 colony forming units (CFU)/mL, while in bronchoalveolar lavage, cerebrospinal fluid, and whole blood, it was 100 CFU/mL. Accuracy and specificity were both 100%, and all specimen types were stable for 8 days at 4°C. Finally, 38 clinical specimens were tested to further evaluate the assay. The performance characteristics met Clinical Laboratory Improvement Amendments standards for a clinical diagnostic assay, and the assay offers a sensitive and specific real-time PCR test for direct detection of S. pneumoniae in relevant clinical specimens.
Collapse
Affiliation(s)
- Subathra Marimuthu
- Division of Infectious Diseases, Infectious Diseases Laboratory, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Rocio B Damiano
- Division of Infectious Diseases, Infectious Diseases Laboratory, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Leslie A Wolf
- Division of Infectious Diseases, Infectious Diseases Laboratory, School of Medicine, University of Louisville, Louisville, Kentucky.
| |
Collapse
|
2
|
Nielsen LE, Mahlen S, Sutter DE. Will Antigen Testing Remain Relevant in the Point-of-Care Testing Environment? Clin Lab Med 2023; 43:167-179. [PMID: 37169440 DOI: 10.1016/j.cll.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Before the molecular age, cell culture was the gold standard for confirmatory diagnosis of viral and atypical infectious diseases. Typical cell culture methodologies are costly, require days (or weeks) for results, and require significant technical expertise. As a result, cell culture is impractical for timely diagnostic testing in most of the health care environments. Traditional bacterial culture methods, also have disadvantages due to the need for incubation, subsequent identification of pathogens, and significant technical expertise. This article discusses the general considerations of antigen and molecular assays and the merits and factors to consider when implementing diagnostic assays for several common pathogens.
Collapse
|
3
|
Garcia Gonzalez J, Hernandez FJ. Nuclease activity: an exploitable biomarker in bacterial infections. Expert Rev Mol Diagn 2022; 22:265-294. [PMID: 35240900 DOI: 10.1080/14737159.2022.2049249] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In the increasingly challenging field of clinical microbiology, diagnosis is a cornerstone whose accuracy and timing are crucial for the successful management, therapy, and outcome of infectious diseases. Currently employed biomarkers of infectious diseases define the scope and limitations of diagnostic techniques. As such, expanding the biomarker catalog is crucial to address unmet needs and bring about novel diagnostic functionalities and applications. AREAS COVERED This review describes the extracellular nucleases of 15 relevant bacterial pathogens and discusses the potential use of nuclease activity as a diagnostic biomarker. Articles were searched for in PubMed using terms: "nuclease", "bacteria", "nuclease activity" or "biomarker". For overview sections, original and review articles between 2000 and 2019 were searched for using terms: "infections", "diagnosis", "bacterial", "burden", "challenges". Informative articles were selected. EXPERT OPINION Using the catalytic activity of nucleases offers new possibilities compared to established biomarkers. Nucleic acid activatable reporters in combination with different transduction platforms and delivery methods can be used to detect disease-associated nuclease activity patterns in vitro and in vivo for prognostic and diagnostic applications. Even when these patterns are not obvious or of unknown etiology, screening platforms could be used to identify new disease reporters.
Collapse
Affiliation(s)
- Javier Garcia Gonzalez
- Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden.,Wallenberg Centre for Molecular Medicine (WCMM), Linköping, Sweden.,Nucleic Acids Technologies Laboratory (NAT-lab), Linköping University, Linköping, Sweden
| | - Frank J Hernandez
- Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden.,Wallenberg Centre for Molecular Medicine (WCMM), Linköping, Sweden.,Nucleic Acids Technologies Laboratory (NAT-lab), Linköping University, Linköping, Sweden
| |
Collapse
|
4
|
Homayoonnia S, Lee Y, Andalib D, Rahman MS, Shin J, Kim K, Kim S. Micro/nanotechnology-inspired rapid diagnosis of respiratory infectious diseases. Biomed Eng Lett 2021; 11:335-365. [PMID: 34513114 PMCID: PMC8424173 DOI: 10.1007/s13534-021-00206-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/17/2021] [Accepted: 08/29/2021] [Indexed: 12/18/2022] Open
Abstract
Humans have suffered from a variety of infectious diseases since a long time ago, and now a new infectious disease called COVID-19 is prevalent worldwide. The ongoing COVID-19 pandemic has led to research of the effective methods of diagnosing respiratory infectious diseases, which are important to reduce infection rate and help the spread of diseases be controlled. The onset of COVID-19 has led to the further development of existing diagnostic methods such as polymerase chain reaction, reverse transcription polymerase chain reaction, and loop-mediated isothermal amplification. Furthermore, this has contributed to the further development of micro/nanotechnology-based diagnostic methods, which have advantages of high-throughput testing, effectiveness in terms of cost and space, and portability compared to conventional diagnosis methods. Micro/nanotechnology-based diagnostic methods can be largely classified into (1) nanomaterials-based, (2) micromaterials-based, and (3) micro/nanodevice-based. This review paper describes how micro/nanotechnologies have been exploited to diagnose respiratory infectious diseases in each section. The research and development of micro/nanotechnology-based diagnostics should be further explored and advanced as new infectious diseases continue to emerge. Only a handful of micro/nanotechnology-based diagnostic methods has been commercialized so far and there still are opportunities to explore.
Collapse
Affiliation(s)
- Setareh Homayoonnia
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Yoonjung Lee
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Daniyal Andalib
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Md Sazzadur Rahman
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Jaemyung Shin
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Keekyoung Kim
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
| | - Seonghwan Kim
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4 Canada
| |
Collapse
|
5
|
Barros N, McDermott S, Wong AK, Turbett SE. Case 12-2020: A 24-Year-Old Man with Fever, Cough, and Dyspnea. N Engl J Med 2020; 382:1544-1553. [PMID: 32294350 DOI: 10.1056/nejmcpc1916256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nicolas Barros
- From the Department of Infectious Diseases, Indiana University School of Medicine, Indianapolis (N.B.); and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Shaunagh McDermott
- From the Department of Infectious Diseases, Indiana University School of Medicine, Indianapolis (N.B.); and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Alexandra K Wong
- From the Department of Infectious Diseases, Indiana University School of Medicine, Indianapolis (N.B.); and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Sarah E Turbett
- From the Department of Infectious Diseases, Indiana University School of Medicine, Indianapolis (N.B.); and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Radiology (S.M.), Medicine (A.K.W., S.E.T.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
| |
Collapse
|
6
|
Pizzutti K, Perez VP, Barbiero C, d'Azevedo PA, Fischer GB, Dias C. Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture-independent methods? Pediatr Pulmonol 2020; 55:484-489. [PMID: 31738021 DOI: 10.1002/ppul.24568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 10/29/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate culture-independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture-negative pleural fluid (PF) in children. METHOD Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture-independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real-time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of β-lactam agents, in PF samples. RESULTS We tested 36 PF specimens and recorded the previous use of antimicrobials. In the final analysis, 34 samples were included. IMT and qPCR presented positive results in 23 (67.6%) and 24 (70.6%) of the samples, respectively, showing a moderate agreement (k = 0.518) between the two methods. From the 36 children included, 34 (94.4%) had antibiotic data available by the time when PFs were collected. Thirty-four (100%) children had been given treatment before PF sampling, with 33 (97%) receiving β-lactam antibiotics administered empirically. Of the 24 lytA real-time positive samples, 21 (87.5%) were also positive for pbp2b, a marker of β-lactam susceptibility. CONCLUSION The reduced sensitivity of culture for pneumococcal detection can be improved through the addition of IMT and qPCR analysis. The utility of qPCR combining detection of lytA and a marker of β-lactam susceptibility should be explored further.
Collapse
Affiliation(s)
- Kauana Pizzutti
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinícius P Perez
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Caroline Barbiero
- Pediatric Pneumology, Hospital da Criança Santo Antônio da Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro A d'Azevedo
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gilberto B Fischer
- Pediatric Pneumology, Hospital da Criança Santo Antônio da Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cícero Dias
- Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
7
|
|
8
|
Li X, Chen B, Zhang S, Li X, Chang J, Tang Y, Wu Y, Lu X. Rapid Detection of Respiratory Pathogens for Community-Acquired Pneumonia by Capillary Electrophoresis-Based Multiplex PCR. SLAS Technol 2018; 24:105-116. [PMID: 30048599 DOI: 10.1177/2472630318787452] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Community-acquired pneumonia (CAP) is a common infectious disease linked to high rates of morbidity and mortality. Fast and accurate identification of the pathogens responsible for CAP will aid in diagnosis. We established a capillary electrophoresis-based multiplex PCR (CEMP) panel to enable the detection of viral and bacterial pathogens associated with CAP. The assay simultaneously detects and identifies the 13 common unculturable CAP viral and bacterial pathogens within 4 h. We evaluated the performance of a commercially available panel with 314 samples collected from CAP patients. We compared the results to those obtained with the liquid chip-based Luminex xTAG Respiratory Viral Panel (RVP) Fast Kit (for viruses) and the agarose gel-based Seegene PneumoBacter ACE Detection Kit (for atypical bacteria). All positive samples were further verified by the Sanger sequencing method. The sensitivity, specificity, positive predictive value, and negative predictive value of CEMP were 97.31%, 100%, 100%, and 99.85%, respectively. CEMP provides a rapid and accurate method for the high-throughput detection of pathogens in patients with CAP.
Collapse
Affiliation(s)
- Xue Li
- 1 Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,2 College of Medicine, Capital Medical University, Beijing, China
| | - Bo Chen
- 3 Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Shaoya Zhang
- 1 Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiuyuan Li
- 1 Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,2 College of Medicine, Capital Medical University, Beijing, China
| | - Junxia Chang
- 4 Department of Laboratory Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yanyan Tang
- 1 Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,2 College of Medicine, Capital Medical University, Beijing, China
| | - Yong Wu
- 3 Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Xinxin Lu
- 1 Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,2 College of Medicine, Capital Medical University, Beijing, China
| |
Collapse
|
9
|
lytA Quantitative PCR on Sputum and Nasopharyngeal Swab Samples for Detection of Pneumococcal Pneumonia among the Elderly. J Clin Microbiol 2017; 56:JCM.01231-17. [PMID: 29118170 PMCID: PMC5744198 DOI: 10.1128/jcm.01231-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/22/2017] [Indexed: 11/20/2022] Open
Abstract
Real-time quantitative PCR (qPCR) assay of sputum or nasopharyngeal specimens has shown promising results in the detection of pneumococcal community-acquired pneumonia (PncCAP). We applied qPCR for the autolysin gene (lytA) and compared sputum and nasopharyngeal swab (NPS) pneumococcal loads in elderly patients with community-acquired pneumonia (CAP), and specifically in patients with PncCAP, to those in patient groups with other respiratory diseases. We studied patients aged ≥65 years with radiologically confirmed CAP, clinical CAP not retrospectively radiologically confirmed, other acute respiratory infections, or stable chronic lung disease. Pneumococcal etiology of CAP was ascertained by using a combination of multiple diagnostic methods. We analyzed sputum and NPS specimens by lytA qPCR with 104 pneumococcal genome equivalents (GE)/ml as a cutoff for positivity. Among PncCAP patients, lytA qPCR detected pneumococci in 94% of the sputum samples and in large quantities (mean, 6.82 ± 1.02 log10 GE/ml) but less frequently in NPS (44%) and in smaller quantities (5.55 ± 0.92 log10 GE/ml). In all other patient groups, ≤10% of the sputum samples and <5% of the NPS samples were lytA qPCR positive; but when they were positive, the sputum pneumococcal loads were similar to those in the PncCAP patients, suggesting a pneumococcal etiology in these patients. This was supported by other pneumococcal assay results. Overall, sputum lytA qPCR positivity was more common in PncCAP patients than in the other patient groups, but the quantitative results were mainly similar. NPS lytA qPCR was less sensitive than sputum lytA qPCR in detecting PncCAP.
Collapse
|
10
|
Yin JK, Jayasinghe SH, Charles PG, King C, Chiu CK, Menzies RI, McIntyre PB. Determining the contribution of
Streptococcus pneumoniae
to community‐acquired pneumonia in Australia. Med J Aust 2017; 207:396-400. [DOI: 10.5694/mja16.01102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Sanjay H Jayasinghe
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | | | - Catherine King
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | - Clayton K Chiu
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | | | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| |
Collapse
|
11
|
Sings HL. Pneumococcal conjugate vaccine use in adults - Addressing an unmet medical need for non-bacteremic pneumococcal pneumonia. Vaccine 2017; 35:5406-5417. [PMID: 28602602 DOI: 10.1016/j.vaccine.2017.05.075] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/04/2017] [Accepted: 05/24/2017] [Indexed: 11/17/2022]
Abstract
Streptococcus pneumoniae is a frequent cause of community acquired pneumonia (CAP), with the largest burden of disease attributed to non-bacteremic pneumonia. Due to the high persistent burden of disease, pneumococcal pneumonia, particularly non-bacteremic pneumococcal pneumonia, continues to be a major public health concern. There are currently two pneumococcal vaccines approved for use in adults in the United States (US) and other countries worldwide: a 23-valent pneumococcal simple polysaccharide vaccine (PPV23), and a 13-valent pneumococcal conjugate vaccine (PCV13). The capsular polysaccharides included in PPV23 induce antibodies primarily by a T-cell independent mechanism, thus the immune response is short lived and lacks the ability to elicit an anamnestic response. PCV13, on the other hand, has the bacterial polysaccharides covalently conjugated to an immunogenic carrier protein resulting in the formation of memory B lymphocytes, thus proving long-acting immunologic memory and an anamnestic response. Despite 30years of use, the question of PPV23 vaccine efficacy, particularly with respect to efficacy for non-bacteremic pneumonia, has been extensively debated and investigated; whereas PCV13 efficacy against vaccine-type pneumococcal CAP, both bacteremic and non-bacteremic, was confirmed in a large randomized controlled trial in older adults. PCV13 was approved under the US Food and Drug Administration's accelerated pathway, which allows for earlier approval of products that provide meaningful benefit over existing treatments - in this case, protection of adults from non-bacteremic pneumococcal pneumonia. Its use is now increasingly recommended globally. This article summarizes the history and use of PPV23 and PCV13 in adults and how vaccination of adults with PCV13 addresses an unmet medical need.
Collapse
|
12
|
Using Nucleic Acid Amplification Techniques in a Syndrome-Oriented Approach: Detection of Respiratory Agents. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
13
|
Leonard DG. Respiratory Infections. MOLECULAR PATHOLOGY IN CLINICAL PRACTICE 2016. [PMCID: PMC7123443 DOI: 10.1007/978-3-319-19674-9_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The majority of respiratory tract infections (RTIs) are community acquired and are the single most common cause of physician office visits and among the most common causes of hospitalizations. The morbidity and mortality associated with RTIs are significant and the financial and social burden high due to lost time at work and school. The scope of clinical symptoms can significantly overlap among the respiratory pathogens, and the severity of disease can vary depending on patient age, underlying disease, and immune status, thereby leading to inaccurate presumptions about disease etiology. The rapid and accurate diagnosis of the causative agent of RTIs improves patient care, reduces morbidity and mortality, promotes effective hospital bed utilization and antibiotic stewardship, and reduces length of stay. This chapter focuses on the clinical utility, advantages, and disadvantages of viral and bacterial tests cleared by the Food and Drug Administration (FDA), and new promising technologies for the detection of bacterial agents of pneumonia currently in development or in US FDA clinical trials are briefly reviewed.
Collapse
Affiliation(s)
- Debra G.B. Leonard
- Pathology and Laboratory Medicine, University of Vermont College of Medicine and University of Vermont Medical Center, Burlington, Vermont USA
| |
Collapse
|
14
|
Usefulness of pneumococcal antigen urinary testing in the intensive care unit? Med Mal Infect 2015; 45:318-23. [PMID: 26344817 DOI: 10.1016/j.medmal.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/02/2015] [Accepted: 08/05/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The use of pneumococcal antigen urinary tests is substantially increasing and is associated with a significant cost. The relevant use of this test in the intensive care unit (ICU) should be better defined. Our aim was to define the role of this test in relation to other microbiological tests. We described a series of patients admitted to the ICU for an invasive pneumococcal disease (IPD). PATIENTS AND METHODS We conducted a retrospective and descriptive study of the microbiological tests used to diagnose IPD in patients admitted to the ICU of the University Hospital in Bordeaux. Our aim was to measure the sensitivity of these bacteriological tests and of the BinaxNOWS. pneumoniae test. RESULTS Between 2009 and 2013, 148 patients were admitted for an IPD. A lower respiratory tract infection was diagnosed in 96.6% of them (143 patients). The overall ICU case fatality rate was 17.6%. The sensitivity of the pneumococcal antigen urinary test, sputum bacteriological examination, and blood cultures was respectively 83%, 37.6%, and 29.7%. S. pneumoniae was isolated from at least one bacteriological sample in 48.6% of patients, but in 51.4%, the diagnosis was only based on the results of the pneumococcal antigen urinary test. CONCLUSION We suggest performing a pneumococcal antigen urinary test when an IPD is suspected, only if the bacteriological tests are still negative after 48hours. This strategy would result in a substantial cost saving. Patients would not face any additional risks as the result of the pneumococcal antigen urinary test does not have any impact on the initially prescribed antibiotic therapy.
Collapse
|
15
|
TRUCCHI C, PAGANINO C, ANSALDI F. Methodological criticisms in the evaluation of Pneumococcal Conjugate Vaccine effectiveness. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2015; 56:E144-9. [PMID: 26788736 PMCID: PMC4755124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/22/2015] [Indexed: 11/13/2022]
Abstract
Globally, lower respiratory tract infections (LRTIs), including community-acquired pneumonia (CAP), cause considerable of morbidity and mortality in adults, especially in the elderly. In addition to age, underlying medical conditions are associated with an increased risk of CAP. From an aetiological point of view, Streptococcus pneumoniae is the leading cause of adult CAP throughout the world. Two types of vaccine are available for the prevention of pneumococcal diseases: the pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccine (PCV7, PCV10 and PCV13). An accurate understanding of the LRTIs burden and the types of subjects at risk of CAP, allow to find an appropriately targeted immunization strategy and provide baseline data to evaluate pneumococcal vaccine effectiveness. Given the high variability in available estimates of LRTIs burden and associated risk factors, the objective of the study was to discuss the methodological criticism in its evaluation, in the light of the gradual introduction of PCV13 immunization strategy targeted to elderly and risk groups in middle-high income countries.
Collapse
Affiliation(s)
- C. TRUCCHI
- Department of Health Sciences (DiSSal), University of Genoa, Italy;,Cecilia Trucchi, Department of Health Sciences (DiSSal), University of Genoa, via A. Pastore, 1, 16132 Genoa, Italy - Tel. +39 010 5552333 - E-mail:
| | - C. PAGANINO
- Department of Health Sciences (DiSSal), University of Genoa, Italy
| | - F. ANSALDI
- Department of Health Sciences (DiSSal), University of Genoa, Italy;, OU Clinical Governance and Hospital Organization, IRCCS AOU San Martino – IST, Genoa, Italy
| |
Collapse
|
16
|
Hirvonen JJ, Seiskari T, Harju I, Rantakokko-Jalava K, Vuento R, Aittoniemi J. Use of an automated PCR assay, the GenomEra S. pneumoniae, for rapid detection of Streptococcus pneumoniae in blood cultures. Infect Dis (Lond) 2015; 47:796-800. [PMID: 26162002 DOI: 10.3109/23744235.2015.1063157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae is recognized as a major cause of pneumonia, meningitis, and bacteremia. Since the mortality rate for pneumococcal bacteremia remains high, the reliable detection of the bacterium in blood samples is important. In this study, the performance of a new automated PCR assay, the GenomEra(™) S. pneumoniae, for direct detection of S. pneumoniae in blood cultures was investigated. METHODS In total, 200 samples were analyzed, including 90 previously identified culture collection isolates and 110 blood culture specimens. The species identification was confirmed with routine diagnostic methods including MALDI-TOF or 16S rDNA sequencing. RESULTS From culture collection, the GenomEra S. pneumoniae assay correctly identified all 37 S. pneumoniae isolates consisting of 18 different serotypes, while all 53 non-S. pneumoniae isolates yielded negative test results. Of 110 blood culture specimens, 46 grew S. pneumoniae and all were positive by the GenomEra assay direct from bottle. The detection sensitivity and specificity of the GenomEra assay for direct analysis of S. pneumoniae in signal positive blood culture bottles was 100%, respectively. With a straightforward sample preparation protocol of blood cultures the results were available within 55 min, thus being significantly quicker than by the routinely used identification methods (18-48 h). The two-step, time-resolved fluorometric measurement mode employed by the GenomEra CDX(™) instrument showed no interference from blood or charcoal. CONCLUSION The GenomEra S. pneumoniae assay is a tool that performs well for the rapid and reliable detection of S. pneumoniae in blood cultures.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Elberse K, van Mens S, Cremers AJ, Meijvis SCA, Vlaminckx B, de Jonge MI, Meis JF, Blauwendraat C, van de Pol I, Schouls LM. Detection and serotyping of pneumococci in community acquired pneumonia patients without culture using blood and urine samples. BMC Infect Dis 2015; 15:56. [PMID: 25885896 PMCID: PMC4330648 DOI: 10.1186/s12879-015-0788-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background Treatment of community acquired pneumonia (CAP) patients with antibiotics before laboratory-confirmed diagnosis leads to loss of knowledge on the causative bacterial pathogen. Therefore, an increasing number of pneumococcal infections is identified using non-culture based techniques. However, methods for serotyping directly on the clinical specimen remain scarce. Here we present three approaches for detection and serotyping of pneumococci using samples from patients with CAP. Methods The first approach is quantitative PCR (qPCR) analysis on blood samples (n = 211) followed by capsular sequence typing (CST) to identify the serotype. The second approach, a urinary antigen assay (n = 223), designated as inhibition multiplex immunoassay (IMIA), is based on Luminex technology targeting 14 serotypes. The third approach is a multiplex immunoassay (MIA) (n = 171) also based on Luminex technology which detects serologic antibody responses against 14 serotypes. The three alternative assays were performed on samples obtained from 309 adult hospitalized CAP patients in 2007–2010 and the results were compared with those obtained from conventional laboratory methods to detect pneumococcal CAP, i.e. blood cultures, sputum cultures and BinaxNOW® urinary antigen tests. Results Using qPCR, MIA and IMIA, we were able to detect the pneumococcus in samples of 56% more patients compared to conventional methods. Furthermore, we were able to assign a serotype to the infecting pneumococcus from samples of 25% of all CAP patients, using any of the three serotyping methods (CST, IMIA and MIA). Conclusion This study indicates the usefulness of additional molecular methods to conventional laboratory methods for the detection of pneumococcal pneumonia. Direct detection and subsequent serotyping on clinical samples will improve the accuracy of pneumococcal surveillance to monitor vaccine effectiveness.
Collapse
Affiliation(s)
- Karin Elberse
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Laboratory for Infectious Diseases and Perinatal Screening, Antonie van Leeuwenhoeklaan 9, P.O.Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Suzan van Mens
- Departments of Medical Microbiology & Immunology, Sint Antonius Hospital Nieuwegein, P.O box 2500, 3430 EM, Nieuwegein, The Netherlands.
| | - Amelieke J Cremers
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Sabine C A Meijvis
- Department of Internal medicine, Sint Antonius Hospital Nieuwegein, P.O box 2500, 3430 EM, Nieuwegein, The Netherlands.
| | - Bart Vlaminckx
- Departments of Medical Microbiology & Immunology, Sint Antonius Hospital Nieuwegein, P.O box 2500, 3430 EM, Nieuwegein, The Netherlands.
| | - Marien I de Jonge
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Jacques F Meis
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
| | - Cornelis Blauwendraat
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Laboratory for Infectious Diseases and Perinatal Screening, Antonie van Leeuwenhoeklaan 9, P.O.Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Ingrid van de Pol
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Laboratory for Infectious Diseases and Perinatal Screening, Antonie van Leeuwenhoeklaan 9, P.O.Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Leo M Schouls
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Laboratory for Infectious Diseases and Perinatal Screening, Antonie van Leeuwenhoeklaan 9, P.O.Box 1, 3720 BA, Bilthoven, The Netherlands.
| |
Collapse
|
19
|
Watanabe H, Uruma T, Tazaki G, Kikuchi R, Tsuji T, Itoh M. Clinical factors associated with negative urinary antigen tests implemented for the diagnosis of community-acquired pneumococcal pneumonia in adult patients. Med Princ Pract 2015; 24:189-94. [PMID: 25613456 PMCID: PMC5588210 DOI: 10.1159/000369931] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 11/17/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study investigated clinical factors associated with negative urinary antigen tests (UAT) implemented for the diagnosis of pneumococcal community-acquired pneumonia (CAP) in adult patients. SUBJECTS AND METHODS We reviewed the medical records of 755 adult patients who completed the UAT in our hospital between 2009 and 2012. Of these, we evaluated 63 patients with bacteriologically confirmed definite pneumococcal CAP (33 were UAT-positive, and 30 were UAT-negative). RESULTS There was no significant difference between the UAT-positive and the UAT-negative patients regarding age, dehydration, respiratory failure, orientation, blood pressure (ADROP) score (the CAP severity score proposed by the Japanese Respiratory Society), gender, white blood cell counts, liver/kidney function tests, or urinalysis. However, serum C-reactive protein (CRP) concentrations were 31% lower in the UAT-negative patients than in the UAT-positive patients (p = 0.02). Furthermore, the prothrombin time-international normalized ratio was 50% higher in the UAT-negative patients than in the UAT-positive patients, although the difference did not reach statistical significance (p = 0.06). The prevalence of comorbidities was similar in both UAT-positive and UAT-negative patients. However, warfarin had been prescribed in 8 (27%) of the UAT-negative patients compared to only 1 (3%) of the UAT-positive patients (odds ratio = 11.6; p = 0.01). CONCLUSIONS These results suggested that low serum CRP concentrations and the use of warfarin increased the possibility with which false-negative UAT results occurred in these patients with pneumococcal CAP.
Collapse
Affiliation(s)
- Hidehiro Watanabe
- Department of Respiratory Medicine and Infection Control, Tokyo Medical University Ibaraki Medical Center, Inashiki, Japan
- Department of Respiratory Medicine, Tokai University, Hachioji Hospital, Tokyo, Japan
- * Hidehiro Watanabe, Department of Respiratory Medicine and Infection Control, Tokyo Medical University Ibaraki Medical Center, 3-20-2 Chuou Ami, Inashiki 300-0395 (Japan), E-Mail
| | - Tomonori Uruma
- Department of Respiratory Medicine and Infection Control, Tokyo Medical University Ibaraki Medical Center, Inashiki, Japan
- Department of Respiratory Medicine, Tokai University, Hachioji Hospital, Tokyo, Japan
| | - Gen Tazaki
- Department of Respiratory Medicine, Tokai University, Hachioji Hospital, Tokyo, Japan
| | - Ryota Kikuchi
- Department of Respiratory Medicine and Infection Control, Tokyo Medical University Ibaraki Medical Center, Inashiki, Japan
| | - Takao Tsuji
- Department of Respiratory Medicine and Infection Control, Tokyo Medical University Ibaraki Medical Center, Inashiki, Japan
| | - Masayuki Itoh
- Department of Respiratory Medicine and Infection Control, Tokyo Medical University Ibaraki Medical Center, Inashiki, Japan
| |
Collapse
|
20
|
Affiliation(s)
- Daniel M Musher
- From the Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, and the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine - both in Houston (D.M.M.); and the Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston (A.R.T.)
| | | |
Collapse
|
21
|
Thellier D, Georges H, Leroy O. [Which samples to obtain in the emergency department for the microbiological diagnosis of community-acquired pneumonia in the immunocompetent patient?]. MEDECINE INTENSIVE REANIMATION 2014; 23:490-497. [PMID: 32288739 PMCID: PMC7117809 DOI: 10.1007/s13546-014-0923-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/08/2014] [Indexed: 11/01/2022]
Abstract
Current diagnostic methods allow microbial identification in 50% of patients admitted with severe community-acquired pneumonia (CAP). Guidelines derived from epidemiological data help physicians to start empirical antimicrobial therapy. Definitive microbial diagnosis is useful to guide further pathogen-directed therapy. Blood cultures, cultures of respiratory specimens and urine antigen tests are recommended to determine the causative bacterial pathogen. Positive blood cultures range from 15 to 25% of CAP patients according to severity. Whether sputum specimens represent or not lower respiratory secretions determines its accuracy in CAP microbial diagnosis. In intubated patients, endotracheal aspirates are often of interest. Detection of positive pneumococcal or legionella urinary antigen is often associated with CAP severity. The sensitivity of this test is not decreased in patients who have received antibiotics prior to sampling. Viral pneumonia account for 10 to 40% of severe CAP. Nasal swabs are recommended for influenza identification using polymerase chain reaction (PCR) in order to deliver oseltamivir treatment. In the emergency department, atypical pneumonia serology is less useful than respiratory specimens obtained using fiberoptic bronchoscopy. Serum PCR to diagnose bacterial CAP is not superior to the other usual methods.
Collapse
Affiliation(s)
- D. Thellier
- Service de réanimation médicale et maladies infectieuses, centre hospitalier Chatilliez, 135 rue du Président Coty, F-59208 Tourcoing, France
| | - H. Georges
- Service de réanimation médicale et maladies infectieuses, centre hospitalier Chatilliez, 135 rue du Président Coty, F-59208 Tourcoing, France
| | - O. Leroy
- Service de réanimation médicale et maladies infectieuses, centre hospitalier Chatilliez, 135 rue du Président Coty, F-59208 Tourcoing, France
| |
Collapse
|
22
|
Zalacain R, Capelastegui A, Ruiz LA, Bilbao A, Gomez A, Uranga A, España PP. Streptococcus pneumoniae antigen in urine: diagnostic usefulness and impact on outcome of bacteraemic pneumococcal pneumonia in a large series of adult patients. Respirology 2014; 19:936-43. [PMID: 24976113 DOI: 10.1111/resp.12341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/13/2014] [Accepted: 04/27/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary pneumococcal antigen detection provides good results in the diagnosis of pneumococcal pneumonia but has rarely been used in bacteraemic pneumococcal pneumonia and it is not known whether it is associated with outcome in this type of pneumonia. Our objectives were to assess the usefulness of an immunochromatographic technique for detecting the pneumococcal antigen in urine in a large prospective study of patients with bacteraemic pneumococcal pneumonia and explore any potential association with outcomes. METHODS This study, carried out over 8 years, included all adult immunocompetent patients admitted for bacteraemic pneumococcal pneumonia. An immunochromatographic test for the Streptococcus pneumoniae antigen in urine was performed in the first 24 h. The sensitivity of test was assessed and patients were divided into two groups according to test results to explore differences on admission and during the course of the illness using logistic regression models. RESULTS Of the 350 patients with bacteraemic pneumococcal pneumonia included, 261 (74.6%) were positive for the antigen. Patient characteristics were very similar on admission and differences in severity (Pneumonia Severity Index) were not statistically significant. In the adjusted analysis, antigen-positive patients had a higher risk of intensive care unit admission, treatment failure and adverse outcome. CONCLUSIONS The sensitivity of the immunochromatographic urinary antigen test was 74.6% and positive results were associated with poorer clinical outcome. We therefore recommend systematic use of this test when pneumonia is diagnosed in the emergency department.
Collapse
Affiliation(s)
- Rafael Zalacain
- Department of Respiratory Medicine, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | | | | | | | | | | | | |
Collapse
|
23
|
The Urinary Antigen Tests have High Sensitivity in Diagnosis of Pneumococcus Caused Community-Acquired Pneumonia Posterior to Antimicrobial Therapy. Cell Biochem Biophys 2014; 70:1029-34. [DOI: 10.1007/s12013-014-0015-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
24
|
Clinical evaluation of a disposable amperometric magneto-genosensor for the detection and identification of Streptococcus pneumoniae. J Microbiol Methods 2014; 103:25-8. [PMID: 24858449 DOI: 10.1016/j.mimet.2014.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 11/22/2022]
Abstract
A disposable PCR-based amperometric magneto-genosensor for detection and identification of Streptococcus pneumoniae was evaluated. ROC curve analysis used to determine optimal signal cutoff values yielded a sensitivity of 91% and a specificity of 90%. The method was also tested for the direct detection of pneumococci in clinical samples.
Collapse
|
25
|
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.
Collapse
|
26
|
Vančíková Z, Trojánek M, Zemličková H, Blechová Z, Motlová J, Matějková J, Nyč O, John J, Malý M, Marešová V. Pneumococcal urinary antigen positivity in healthy colonized children: is it age dependent? Wien Klin Wochenschr 2013; 125:495-500. [PMID: 23928934 DOI: 10.1007/s00508-013-0405-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pneumococcal urinary antigen test is a valuable tool for diagnosing pneumococcal pneumonia and meningitis in adults. Its use in children is generally not accepted because of nonspecificity at this age. It is frequently positive in asymptomatic nasopharyngeal carriers. The aim of our study was to assess the age limit from which the test is no longer positive in asymptomatic healthy carriers. METHODS A total of 197 children aged 36-83 months attending 9 day care centers in Prague were enrolled during February and March 2010. Nasopharyngeal swab specimens were collected from each participant and selectively cultivated. The presence of pneumococcal antigen in urine was detected by BinaxNOW® S. pneumoniae kit. RESULTS Streptococcus pneumoniae was cultivated in 53.3 % of healthy children with the highest colonization rate (59.3 %) in children aged 48-59 months. The most frequently colonizing serotypes were: 19F, 23F, 3, 19A, 6B and 4. The presence of pneumococcal antigen in urine decreased with age from 39.0 % in 36-47 months to 17.9 % in 72-83 months old (p = 0.031). The antigen positivity was serotype-dependent and more frequent in nonvaccinated children. CONCLUSION We demonstrated age-dependent linear decrease of pneumococcal antigen excretion into urine in healthy children. The positivity rate of the test in children aged 72-83 months was similar to that referred in healthy adults, irrespective of colonization. To confirm this age limit for use of this test in diagnostics of pneumococcal diseases, further study in school-age children is justified.
Collapse
Affiliation(s)
- Zuzana Vančíková
- Department of Paediatrics, Hořovice Hospital, NH Hospital, Hořovice, Czech Republic
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
Community-acquired pneumonia (CAP) accounts for major morbidity and mortality in the United States. With improved broad-spectrum antibiotics, the implementation of diagnostic studies has declined and most patients do not have an etiologic pathogen of CAP identified. To enhance the appropriate use of antiviral agents and prevent overuse of antibiotics, the successful management of CAP requires rapid and accurate diagnosis of the etiologic agent of CAP. This article provides an overview of the new rapid molecular tests for the diagnosis of influenza, other respiratory viruses, and bacteria compared with nonmolecular tests and how their use for directed therapy can enhance and improve the management of CAP.
Collapse
Affiliation(s)
- Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
| |
Collapse
|
28
|
Systematic review and meta-analysis of a urine-based pneumococcal antigen test for diagnosis of community-acquired pneumonia caused by Streptococcus pneumoniae. J Clin Microbiol 2013; 51:2303-10. [PMID: 23678060 DOI: 10.1128/jcm.00137-13] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Standard culture methods for diagnosis of Streptococcus pneumoniae pneumonia take at least 24 h. The BinaxNOW urine-based test for S. pneumoniae (BinaxNOW-SP) takes only 15 min to conduct, potentially enabling earlier diagnosis and targeted treatment. This study was conducted to assess whether the use of BinaxNOW-SP at the time of hospital admission would provide adequate sensitivity and specificity for diagnosis of community-acquired pneumonia (CAP) in adult patients. We searched PubMed, EMBASE/OVID, Cochrane Collaboration, Centre for Reviews and Dissemination, INAHTA, and CADTH for diagnostic or etiologic studies of hospitalized predominately adult patients with clinically defined CAP that reported the diagnostic performance of BinaxNOW-SP versus cultures. Two authors independently extracted study details and diagnostic two-by-two tables. We found that 27 studies met our inclusion criteria, and three different reference standards were used between them. A bivariate meta-analysis of 12 studies using a composite of culture tests as the reference standard estimated the sensitivity of BinaxNOW-SP as 68.5% (95% credibility interval [CrI], 62.6% to 74.2%) and specificity as 84.2% (95% CrI, 77.5% to 89.3%). A meta-analysis of all 27 studies, adjusting for the imperfect and variable nature of the reference standard, gave a higher sensitivity of 74.0% (CrI, 66.6% to 82·3%) and specificity of 97.2% (CrI, 92.7% to 99.8%). The analysis showed substantial heterogeneity across studies, which did not decrease with adjustment for covariates. We concluded that the higher pooled sensitivity (compared to culture) and high specificity of BinaxNOW-SP suggest it would be a useful addition to the diagnostic workup for community-acquired pneumonia. More research is needed regarding the impact of BinaxNOW-SP on clinical practice.
Collapse
|
29
|
Abstract
Community-acquired bacterial pneumonia (CAP) remains one of the most common opportunistic infections in patients who are infected with the human immunodeficiency virus (HIV). The risk of CAP increases as the CD4 cell count decreases. The common bacterial pathogens that cause CAP in HIV-infected persons are similar to those in HIV-uninfected individuals, with the pneumococcus being the most common pathogen. Prevention of CAP remains critical and necessitates a comprehensive approach addressing, among many other factors, cigarette smoking cessation strategies, antiretroviral therapy adherence, and immunization against those infections for which effective vaccinations are available.
Collapse
Affiliation(s)
- Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, Johannesburg, South Africa.
| | | |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW After decades of neglect, the importance of establishing an aetiological diagnosis for community-acquired and atypical pneumonias has increased dramatically in recent years--driven by the movement towards more rational use of antibiotics, the further spread of antimicrobial resistance, and advances in point-of-care assays that circumvent the diagnostic delays that result from the centralization of laboratories. RECENT FINDINGS There have been very few developments in patient sampling, or the direct visualization, culture, and serological detection of respiratory pathogens. There has, however, been significant interest in the development of improved and more clinically useful assays for the detection of pathogen nucleic acids and proteins, and also in the potential utility of the assessment of host response for tailoring therapy. SUMMARY The majority of patients have yet to benefit from any advances. However, nucleic acid, newer protein, and possibly host-response assays have significant potential to influence patient care in the near future.
Collapse
|
31
|
Musher DM, Roig IL, Cazares G, Stager CE, Logan N, Safar H. Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study. J Infect 2013; 67:11-8. [PMID: 23523447 PMCID: PMC7132393 DOI: 10.1016/j.jinf.2013.03.003] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 03/07/2013] [Accepted: 03/13/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Determining the cause of community-acquired pneumonia (CAP) remains problematic. In this observational study, we systematically applied currently approved diagnostic techniques in patients hospitalized for CAP in order to determine the proportion in which an etiological agent could be identified. METHODS All patients admitted with findings consistent with CAP were included. Sputum and blood cultures, urine tests for pneumococcal and Legionella antigens, nasopharyngeal swab for viral PCR, and serum procalcitonin were obtained in nearly every case. Admission-related electronic medical records were reviewed in entirety. RESULTS By final clinical diagnosis, 44 patients (17.0%) were uninfected. A causative bacterium was identified in only 60 (23.2%) cases. PCR identified a respiratory virus in 42 (16.2%), 12 with documented bacterial coinfection. In 119 (45.9%), no cause for CAP was found; 69 (26.6%) of these had a syndrome indistinguishable from bacterial pneumonia. Procalcitonin was elevated in patients with bacterial infection and low in uninfected patients or those with viral infection, but with substantial overlap. CONCLUSIONS Only 23.2% of 259 patients admitted with a CAP syndrome had documented bacterial infection; another 26.6% had no identified bacterial etiology, but findings closely resembled those of bacterial infection. Nevertheless, all 259 received antibacterial therapy. Careful attention to the clinical picture may identify uninfected patients or those with viral infection, perhaps with reassurance by a non-elevated procalcitonin. Determining an etiologic diagnosis remains elusive. Better discriminators of bacterial infection are sorely needed.
Collapse
Affiliation(s)
- Daniel M Musher
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Picazo JJ, Contreras JR, Ríos E, Culebras E, Rodríguez-Avial I, Méndez C, Betriu C. Rapid diagnosis of invasive pneumococcal disease in pediatric population. J Microbiol Methods 2013; 93:116-20. [PMID: 23499921 DOI: 10.1016/j.mimet.2013.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the Binax NOW immunochromatographic pneumococcal antigen test for the identification of Streptococcus pneumoniae in pleural and cerebrospinal fluids from children with suspected invasive pneumococcal disease. The results were compared with those obtained by PCR. Binax NOW was applied to these samples as recommended by the manufacturer for urine and cerebrospinal samples. Detection of pneumococcal DNA was performed by real-time PCR assay targeting the autolysin gene (lytA). Of the 199 samples analyzed, 131 were positive by both Binax NOW and lytA PCR, and 36 samples were negative by both techniques. Using the real-time PCR as a comparative method to the Binax for the detection of S. pneumoniae, the sensitivity and specificity of Binax NOW was 88% and 72.5%, respectively. Of the 145 positive samples analyzed by Binax NOW, 119 showed intense coloring of the sample line and 26 showed weak intensity. Conventional culture is the most common method in clinical settings, but Binax NOW is an easier and faster test for identifying S. pneumoniae in pleural and cerebrospinal fluids from children with suspected invasive pneumococcal disease.
Collapse
Affiliation(s)
- Juan Jose Picazo
- Microbiology Department, Hospital Clínico San Carlos, c/ Martín Lagos s/n, 28040 Madrid, Spain
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Recomendaciones para el diagnóstico, tratamiento y prevención de la neumonía adquirida en la comunidad en adultos inmunocompetentes. INFECTIO 2013. [DOI: 10.1016/s0123-9392(13)70019-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
34
|
Hettwer S, Wilhelm J, Schürmann M, Ebelt H, Hammer D, Amoury M, Hofmann F, Oehme A, Wilhelms D, Kekulé AS, Klöss T, Werdan K. Microbial diagnostics in patients with presumed severe infection in the emergency department. Med Klin Intensivmed Notfmed 2012; 107:53-62. [PMID: 22349478 DOI: 10.1007/s00063-011-0051-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test.Methods. At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (≥2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. RESULTS Results of the BC were available in 200 patients (94.8%) and PCR were available in 119 patients (56.3%), respectively. In total, 87 BC (43.5%) were positive and identified 94 pathogens. In 45 positive PCRs, 47 pathogens (37.8%) were found. Identical results were obtained in 81.4%. In addition, BC identified 9 Gram-positive and 3 Gram-negative bacteria, while PCR added 5 Gram-negative pathogens. Coagulase-negative staphylococci were detected in blood cultures only (n=20, 21.3%), whereas PCR identified significantly more Gram-negative bacteria than BC. In patients with positive PCR results, the PCT level was significantly higher than in patients with negative PCR (15.0±23.3 vs. 8.8±32.8 ng/ml, p<0.001). This difference was not observed for BC (10.6±25.7 vs. 11.6±44.9 ng/ml, p=0.075). The APACHE II score correlated with PCR (19.2±9.1 vs. 15.8±8.9, p<0.05) and was also higher in positive BC (18.7±8.7 vs. 14.4±8.0, p<0.01). Positive PCR and BC were correlated with negative clinical outcomes (e.g., transfer to ICU, mechanical ventilation, renal replacement therapy, death). CONCLUSION In patients admitted with suspected severe infection, a high percentage of positive BC and PCR were observed. Positive findings in the PCR correlate with elevated levels of PCT and high APACHE II scores.
Collapse
Affiliation(s)
- S Hettwer
- Department of Medicine III (Cardiology, Angiology and Medical Intensive Care Medicine), University Clinics Halle Ernst-Grube-Str. 40, 06097 Halle (Saale).
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
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.
Collapse
|
36
|
Feikin DR, Njenga MK, Bigogo G, Aura B, Aol G, Audi A, Jagero G, Muluare PO, Gikunju S, Nderitu L, Balish A, Winchell J, Schneider E, Erdman D, Oberste MS, Katz MA, Breiman RF. Etiology and Incidence of viral and bacterial acute respiratory illness among older children and adults in rural western Kenya, 2007-2010. PLoS One 2012; 7:e43656. [PMID: 22937071 PMCID: PMC3427162 DOI: 10.1371/journal.pone.0043656] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/23/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Few comprehensive data exist on disease incidence for specific etiologies of acute respiratory illness (ARI) in older children and adults in Africa. METHODOLOGY/PRINCIPAL FINDINGS From March 1, 2007, to February 28, 2010, among a surveillance population of 21,420 persons >5 years old in rural western Kenya, we collected blood for culture and malaria smears, nasopharyngeal and oropharyngeal swabs for quantitative real-time PCR for ten viruses and three atypical bacteria, and urine for pneumococcal antigen testing on outpatients and inpatients meeting a ARI case definition (cough or difficulty breathing or chest pain and temperature >38.0 °C or oxygen saturation <90% or hospitalization). We also collected swabs from asymptomatic controls, from which we calculated pathogen-attributable fractions, adjusting for age, season, and HIV-status, in logistic regression. We calculated incidence by pathogen, adjusting for health-seeking for ARI and pathogen-attributable fractions. Among 3,406 ARI patients >5 years old (adjusted annual incidence 12.0 per 100 person-years), influenza A virus was the most common virus (22% overall; 11% inpatients, 27% outpatients) and Streptococcus pneumoniae was the most common bacteria (16% overall; 23% inpatients, 14% outpatients), yielding annual incidences of 2.6 and 1.7 episodes per 100 person-years, respectively. Influenza A virus, influenza B virus, respiratory syncytial virus (RSV) and human metapneumovirus were more prevalent in swabs among cases (22%, 6%, 8% and 5%, respectively) than controls. Adenovirus, parainfluenza viruses, rhinovirus/enterovirus, parechovirus, and Mycoplasma pneumoniae were not more prevalent among cases than controls. Pneumococcus and non-typhi Salmonella were more prevalent among HIV-infected adults, but prevalence of viruses was similar among HIV-infected and HIV-negative individuals. ARI incidence was highest during peak malaria season. CONCLUSIONS/SIGNIFICANCE Vaccination against influenza and pneumococcus (by potential herd immunity from childhood vaccination or of HIV-infected adults) might prevent much of the substantial ARI incidence among persons >5 years old in similar rural African settings.
Collapse
Affiliation(s)
- Daniel R Feikin
- Global Disease Detection Division, Centers for Disease Control and Prevention, International Emerging Infections Program, Kisumu, Kenya.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Pride MW, Huijts SM, Wu K, Souza V, Passador S, Tinder C, Song E, Elfassy A, McNeil L, Menton R, French R, Callahan J, Webber C, Gruber WC, Bonten MJM, Jansen KU. Validation of an immunodiagnostic assay for detection of 13 Streptococcus pneumoniae serotype-specific polysaccharides in human urine. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1131-41. [PMID: 22675155 PMCID: PMC3416073 DOI: 10.1128/cvi.00064-12] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/25/2012] [Indexed: 11/20/2022]
Abstract
To improve the clinical diagnosis of pneumococcal infection in bacteremic and nonbacteremic community-acquired pneumonia (CAP), a Luminex technology-based multiplex urinary antigen detection (UAD) diagnostic assay was developed and validated. The UAD assay can simultaneously detect 13 different serotypes of Streptococcus pneumoniae by capturing serotype-specific S. pneumoniae polysaccharides (PnPSs) secreted in human urine. Assay specificity is achieved by capturing the polysaccharides with serotype-specific monoclonal antibodies (MAbs) on spectrally unique microspheres. Positivity for each serotype was based on positivity cutoff values calculated from a standard curve run on each assay plate together with positive- and negative-control urine samples. The assay is highly specific, since significant signals are detected only when each PnPS was paired with its homologous MAb-coated microspheres. Validation experiments demonstrated excellent accuracy and precision. The UAD assay and corresponding positivity cutoff values were clinically validated by assessing 776 urine specimens obtained from patients with X-ray-confirmed CAP. The UAD assay demonstrated 97% sensitivity and 100% specificity using samples obtained from patients with bacteremic, blood culture-positive CAP. Importantly, the UAD assay identified Streptococcus pneumoniae (13 serotypes) in a proportion of individuals with nonbacteremic CAP, a patient population for which the pneumococcal etiology of CAP was previously difficult to assess. Therefore, the UAD assay provides a specific, noninvasive, sensitive, and reproducible tool to support vaccine efficacy as well as epidemiological evaluation of pneumococcal disease, including CAP, in adults.
Collapse
Affiliation(s)
- Michael W Pride
- Vaccine Research East and Early Development, Pfizer Research, Pearl River, New York, New York, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Thiem U, Heppner HJ, Pientka L. Elderly patients with community-acquired pneumonia: optimal treatment strategies. Drugs Aging 2012; 28:519-37. [PMID: 21721597 DOI: 10.2165/11591980-000000000-00000] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Community-acquired pneumonia (CAP) is a common infectious disease that still causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. This article reviews current recommendations of guidelines with a special focus on aspects of the care of elderly patients with CAP. The most common pathogen in CAP is still Streptococcus pneumoniae, followed by other pathogens such as Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella species. Antimicrobial resistance is an increasing problem, especially with regard to macrolide-resistant S. pneumoniae and fluoroquinolone-resistant strains. With regard to β-lactam antibacterials, resistance by H. influenzae and Moraxella catarrhalis is important, as is the emergence of multidrug-resistant Staphylococcus aureus. The main management decisions should be guided by the severity of disease, which can be assessed by validated clinical risk scores such as CURB-65, a tool for measuring the severity of pneumonia based on assessment of confusion, serum urea, respiratory rate and blood pressure in patients aged ≥65 years. For the treatment of low-risk pneumonia, an aminopenicillin such as amoxicillin with or without a β-lactamase inhibitor is frequently recommended. Monotherapy with macrolides is also possible, although macrolide resistance is of concern. When predisposing factors for special pathogens are present, a β-lactam antibacterial combined with a β-lactamase inhibitor, or the combination of a β-lactam antibacterial, a β-lactamase inhibitor and a macrolide, may be warranted. If possible, patients who have undergone previous antibacterial therapy should receive drug classes not previously used. For hospitalized patients with non-severe pneumonia, a common recommendation is empirical antibacterial therapy with an aminopenicillin in combination with a β-lactamase inhibitor, or with fluoroquinolone monotherapy. With proven Legionella pneumonia, a combination of β-lactams with a fluoroquinolone or a macrolide is beneficial. In severe pneumonia, ureidopenicillins with β-lactamase inhibitors, broad-spectrum cephalosporins, macrolides and fluoroquinolones are used. A combination of a broad-spectrum β-lactam antibacterial (e.g. cefotaxime or ceftriaxone), piperacillin/tazobactam and a macrolide is mostly recommended. In patients with a predisposition for Pseudomonas aeruginosa, a combination of piperacillin/tazobactam, cefepime, imipenem or meropenem and levofloxacin or ciprofloxacin is frequently used. Treatment duration of more than 7 days is not generally recommended, except for proven infections with P. aeruginosa, for which 15 days of treatment appears to be appropriate. Further care issues in all hospitalized patients are timely administration of antibacterials, oxygen supply in case of hypoxaemia, and fluid management and dose adjustments according to kidney function. The management of elderly patients with CAP is a challenge. Shifts in antimicrobial resistance and the availability of new antibacterials will change future clinical practice. Studies investigating new methods to detect pathogens, determine the optimal antimicrobial regimen and clarify the duration of treatment may assist in further optimizing the management of elderly patients with CAP.
Collapse
Affiliation(s)
- Ulrich Thiem
- Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany.
| | | | | |
Collapse
|
39
|
Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJM. Guidelines for the management of adult lower respiratory tract infections--summary. Clin Microbiol Infect 2012; 17 Suppl 6:1-24. [PMID: 21951384 DOI: 10.1111/j.1469-0691.2011.03602.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.
Collapse
Affiliation(s)
- M Woodhead
- Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJM. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect 2011; 17 Suppl 6:E1-59. [PMID: 21951385 PMCID: PMC7128977 DOI: 10.1111/j.1469-0691.2011.03672.x] [Citation(s) in RCA: 592] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. Background sections and graded evidence tables are also included. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.
Collapse
Affiliation(s)
- M Woodhead
- Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Gaillat J. Should patients with chronic obstructive pulmonary disease be vaccinated against pneumococcal diseases? Expert Rev Respir Med 2011; 3:585-96. [PMID: 20477349 DOI: 10.1586/ers.09.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past 15 years, no fewer than ten meta-analyses or systematic literature reviews of the efficacy of pneumococcal polysaccharide vaccine in adults have been conducted, including one specifically in chronic obstructive pulmonary disease patients. Their general conclusion is that it is effective in preventing invasive infections, but no conclusions can be drawn for high-risk patients (owing to a highly polymorphic population). Opinions are divided as to its efficacy in pneumonia, with the studies being too heterogeneous to carry sufficient statistical weight. Most conclude that there is no impact on mortality. Chronic obstructive pulmonary disease patients are frequently described as an at-risk population, but controlled studies in such patients are very limited, leaving only case-control or cohort studies to provide information on which to base any decision. The aim of this article is first to discuss the place of pneumococcal polysaccharide vaccination in this risk population, which is increasing in prevalence and in which pneumococcal infections play a considerable role. Pending other vaccines, the polysaccharide vaccine is currently the only preventive approach that has demonstrated an effect, even if it does not match up to expectations. The possibilities of alternative vaccines, such as conjugate vaccines in the near future and perhaps protein vaccines at a later date, will be considered.
Collapse
Affiliation(s)
- Jacques Gaillat
- Service des Maladies Infectieuses, Centre hospitalier de la région d'Annecy, 1 Avenue de l'Hôpital Metz-Tessy, 74374 Pringy cedex, France.
| |
Collapse
|
42
|
Affiliation(s)
- Thomas M File
- Infectious Disease Section, Internal Medicine Department, Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, OH 44272, USA.
| |
Collapse
|
43
|
Blaschke AJ. Interpreting assays for the detection of Streptococcus pneumoniae. Clin Infect Dis 2011; 52 Suppl 4:S331-7. [PMID: 21460292 DOI: 10.1093/cid/cir048] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Streptococcus pneumoniae is both an aggressive pathogen and a normal part of the human respiratory microbiome. Clinicians and microbiologists have struggled to develop tests that can identify pneumococcal respiratory infection and accurately distinguish colonization from invasive disease. Molecular methods hold the promise of an improved ability to rapidly detect microorganisms in respiratory secretions and to make an accurate diagnosis; however, interpretation of diagnostic testing for S. pneumoniae remains problematic. Molecular assays, such as those targeting the pneumolysin gene, may cross-react with other streptococcal species, confounding detection and quantification. Assays that target the autolysin gene appear to be more specific. Even when accurately identified, however, the significance of S. pneumoniae DNA detected in clinical samples is difficult to determine. Here we will discuss the challenges faced in the interpretation of molecular testing for S. pneumoniae, and some strategies that might be used to improve our ability to diagnose pneumococcal respiratory infection.
Collapse
Affiliation(s)
- Anne J Blaschke
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84158, USA.
| |
Collapse
|
44
|
Bartlett JG. Diagnostic tests for agents of community-acquired pneumonia. Clin Infect Dis 2011; 52 Suppl 4:S296-304. [PMID: 21460288 DOI: 10.1093/cid/cir045] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lower respiratory infections are the major cause of death due to infectious disease in the United States and worldwide. Most forms of community-acquired pneumonia (CAP) are treatable, and there is consensus that the selection of antimicrobial agents is notably simplified if the pathogen is defined. The rich history of CAP studies in the prepenicillin era showed that an etiologic diagnosis was established in >90% of cases, but the 2009 data from Medicare indicate that a probable pathogen is now detected in <10% according to a review of the records of >17,000 patients hospitalized with CAP. This review addresses the issue of the state of the art of microbiological studies of CAP in terms of the realities of current-day practice. Unfortunately, the desire for better data to achieve pathogen-directed treatment clashes with a multitude of harsh realities, including cost, Centers for Medicare and Medicaid Services (CMS) requirements for antibiotics to be administered within 6 h of disease onset, guidelines that discourage any microbiological studies in most cases, belief in empiricism that is well supported by at least 1 prospective study, the decline of microbiological analysis standards in most laboratories, and the devastating impact of the Clinical Laboratory Improvement Amendments (CLIA) regulations that led to the demise of "the house staff laboratory" and the distancing of microbiological analysis from the site of care. Microbiological principles are reviewed, with emphasis on specimen source, pathogenic potential of isolates, concentrations, impact of antecedent antibiotics, and the "Washington criteria" for expectorated sputum. The recommendation is that the high-quality microbiological analysis that is still achieved in some places should be retained but that to advance the field on the basis of the contemporary realities, two goals should be adopted: First is the broad use of antigen tests for Streptococcus pneumoniae and Legionella pneumophila with interpretation by clinical staff under the CLIA waiver for low-complexity tests. The second and more ambitious recommendation is the adoption of molecular techniques, with particular emphasis on nucleic acid detection, which is rapid and sensitive and has already been developed for virtually all recognized pulmonary pathogens. This may be the ultimate solution for many laboratories, and it is likely to have selected use.
Collapse
Affiliation(s)
- John G Bartlett
- School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
| |
Collapse
|
45
|
Microbial diagnostics in patients with presumed severe infection in the emergency department. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s00390-011-0287-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
46
|
Abstract
Despite the availability of effective antibiotics and intensive medical care, pneumococcal pneumonia is still associated with substantial mortality. Early diagnosis is becoming increasingly possible. This article reviews several adjunctive measures that might be instituted at or soon after admission in patients who are hospitalized for community-acquired pneumonia that is found to be due to Streptococcus pneumoniae. Available data favor the use of a macrolide together with a β-lactam antibiotic for treatment, based largely on immunomodulatory activity of macrolides. Two large subgroup analyses from a single major study suggest that activated protein C (eg, drotrecogin) should be considered for patients with severe sepsis, organ failure, and an Acute Physiology and Chronic Health Evaluation II score > 25 due to pneumococcal pneumonia. Statins exert an anti-inflammatory effect and several retrospective studies suggest that their use might ameliorate the adverse effects of pneumonia. Because inflammation elsewhere in the body is associated with inflammation in coronary arteries and because pneumococcal pneumonia has been shown to precipitate myocardial infarction, statins might be of further benefit by decreasing the likelihood of associated myocardial infarction. Aspirin, which inhibits platelet aggregation in inflamed coronary arteries, might also be considered for initial therapy. One reason that the association between myocardial infarction and pneumonia was not previously recognized is that aspirin was widely used in the past when people had acute febrile conditions. The literature on the benefits of corticosteroids in pneumonia is not convincing, and a particularly well-done, very recent study shows no benefit with corticosteroid use in patients with pneumococcal pneumonia, and perhaps even a worse outcome. No clinical data favor the use of platelet-activating factor antagonists.
Collapse
Affiliation(s)
- Daniel M Musher
- Infectious Disease Section, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
47
|
Azzari C, Cortimiglia M, Moriondo M, Canessa C, Lippi F, Ghiori F, Becciolini L, de Martino M, Resti M. Pneumococcal DNA is not detectable in the blood of healthy carrier children by real-time PCR targeting the lytA gene. J Med Microbiol 2011; 60:710-714. [PMID: 21349984 PMCID: PMC3167920 DOI: 10.1099/jmm.0.028357-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The diagnosis of invasive pneumococcal disease (IPD) is currently based on culture methods, which lack sensitivity, especially after antibiotic therapy. Molecular methods have improved sensitivity and do not require viable bacteria; however, their use is complicated by reports of low specificity with some assays. The present study investigated the specificity of a real-time PCR targeting lytA for the detection of IPD. A group of 147 healthy children, aged 6 months to 16 years (mean 6.4 years, median 4.9 years, interquartile range 6.4 years), who were in hospital for routine examinations, were tested for pneumococcal carrier status and for the presence of detectable pneumococcal DNA in their blood by real-time PCR targeting the pneumococcal lytA gene. In addition, 35 culture-positive biological samples were analysed. Urine was examined for the presence of pneumococcal DNA and C-polysaccharide antigen. Carriage was detected in 77 of the 147 subjects (52.4 %); however, regardless of carrier status, none of the subjects had a positive result from blood. Analysis of the culture-positive biological samples yielded positive results in 100 % (15/15) of cerebrospinal fluid samples and 95 % (19/20) of blood samples. All urine samples from healthy carriers were negative for DNA, whilst antigenuria was detected in 44/77 carriers (57.1 %). In conclusion, real-time PCR is both sensitive and specific and can be a useful tool in the routine diagnosis of IPD. Its sensitivity, which surpasses that of other methods for this purpose, does not come at the cost of reduced specificity.
Collapse
Affiliation(s)
- Chiara Azzari
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Martina Cortimiglia
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maria Moriondo
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Clementina Canessa
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesca Lippi
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Federica Ghiori
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Laura Becciolini
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Massimo Resti
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| |
Collapse
|
48
|
Campuzano S, Pedrero M, García JL, García E, García P, Pingarrón JM. Development of amperometric magnetogenosensors coupled to asymmetric PCR for the specific detection of Streptococcus pneumoniae. Anal Bioanal Chem 2011; 399:2413-20. [DOI: 10.1007/s00216-010-4645-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/21/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
|
49
|
|
50
|
recA-based PCR assay for accurate differentiation of Streptococcus pneumoniae from other viridans streptococci. J Clin Microbiol 2010; 49:523-7. [PMID: 21147955 DOI: 10.1128/jcm.01450-10] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Proper identification of Streptococcus pneumoniae by conventional methods remains problematic. The discriminatory power of the 16S rRNA gene, which can be considered the "gold standard" for molecular identification, is too low to differentiate S. pneumoniae from closely related species such as Streptococcus pseudopneumoniae, Streptococcus mitis, and Streptococcus oralis in the routine clinical laboratory. A 313-bp part of recA was selected on the basis of variability within the S. mitis group, showing <95.8% interspecies homology. In addition, 6 signature nucleotides specific for S. pneumoniae were identified within the 313-bp recA fragment. We show that recA analysis is a useful tool for proper identification to species level within the S. mitis group, in particular, for pneumococci.
Collapse
|