ALLEWELT M, STETZELBERG H, BURKHARDT O, LODE H, MAUCH H, ROTH A; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. D-123.
Zentralklinik E.-v.-Behring, Berlin, Germany
BACKGROUND: Rapid diagnosis of Streptococcus pneumoniae might help directing antibiotic therapy in a safe and cost-effective way. Binax NOW detects pneumococcal antigen in urine samples (immunochromatography). Sensitivity has only been established in limited numbers of pneumonia patients but not for other lower respiratory tract infections (LRTI). METHODS: We obtained respiratory, blood and urine samples from adults hospitalized for lower respiratory tract infection (LRTI), defined their disease with stringent criteria and tested for etiology of infection. Urine was tested for pneumococcal and legionella antigen, respiratory samples (sputum, bronchial aspirates, BAL, PSB) were used for microscopy, Gram-stain, quantitative culture and PCR (Mycoplasma, Legionella, MTB), blood cultures and serology were performed. RESULTS: In 127 patients (age 21-98 yr), 93 cases of pneumonia were identified, 27 LRTIs without infiltrates, e.g. acute exacerbation of chronic bronchitis (AECB), chronic obstructive lung disease (COLD), and 7 patients with non-infectious lung disease. In 62 (66.7%) cases of pneumonia, a definite etiology was identified. In 44 cases of pneumonia (47.3%), pneumococcal urinary antigen was tested positive and S. pneumoniae was cultured in 35 (74.5%) antigen-positive cases. While in patients without radiographic infiltrates S. pneumoniae was cultured in 23 cases (67.6%), only 3 turned out positive for pneumococcal antigen. When respiratory samples of high quality in conjunction with stringent criteria for pneumonia were considered as standard, sensitivity of urinary antigen in pneumonia was 80.0%, specificity was 93.9%. CONCLUSIONS: Provided that clinical criteria are applied thoroughly, pneumococcal urinary antigen testing might be cost saving in pneumonia by allowing to narrow antibacterial coverage early in disease but it appears without value in other, even severe, LRTI, such as COPD or AECB.
Publication Types:
Keywords:
- Adult
- Antigens, Bacterial
- Bronchitis, Chronic
- Humans
- Legionella
- Mycoplasma
- Pneumococcal Vaccines
- Pneumonia
- Pneumonia, Bacterial
- Pneumonia, Pneumococcal
- Pulmonary Disease, Chronic Obstructive
- Respiratory Tract Infections
- Sensitivity and Specificity
- Sputum
- Streptococcus pneumoniae
- Thoracic Diseases
- Urogenital System
- Virus Diseases
- immunology
Other ID:
UI: 102266827
From Meeting Abstracts