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S treptococcus pneumoniae antigen in urine: Diagnostic usefulness and impact on outcome of bacteraemic pneumococcal pneumonia in a large series of adult patients
Author(s) -
Zalacain Rafael,
Capelastegui Alberto,
Ruiz Luis Alberto,
Bilbao Amaia,
Gomez Ainhoa,
Uranga Ane,
España Pedro P.
Publication year - 2014
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12341
Subject(s) - medicine , pneumonia , pneumococcal pneumonia , streptococcus pneumoniae , urine , antigen , urinary system , prospective cohort study , community acquired pneumonia , intensive care unit , logistic regression , immunology , antibiotics , microbiology and biotechnology , biology
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 S treptococcus 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 ( P neumonia S everity I ndex) 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.