Pneumococcal Community-Acquired Pneumonia Detected by Serotype-Specific Urinary Antigen Detection Assays

Wunderink, Richard G.; Self, Wesley H.; Anderson, Evan J.; Balk, R.A.; Fakhran, Sherene; Courtney, D. Mark; Qi, Chao; Williams, Derek J.; Zhu, Yuwei; Whitney, Cynthia G.; Moore, Matthew R.; Bramley, Anna M.; Jain, Seema; Edwards, Kathryn M.; Grijalva, Carlos G.

doi:10.1093/cid/cix1066

Cited by 49 publications

(45 citation statements)

References 39 publications

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“…The most commonly available Legionella urinary antigen assays have a sensitivity of around 80% for serogroup 1 infection (approximately 85% of infections in the US and Europe), but do not detect other serotypes. Advances in urine antigen detection tests for patients with pneumonia mean that new kits show greater sensitivity, can detect S. pneumoniae and L. pneumophila in a single test, and can detect pneumococcal serotypes [23,25]. We have to mention that urine antigen testing has only really been validated in adult (not paediatric) patients.…”

Section: Non-cultured Based Methodsmentioning

confidence: 99%

Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

Liapikou

Cillóniz

2019

Expert Review of Anti-infective Therapy

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Section: Non-cultured Based Methodsmentioning

confidence: 99%

Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

Liapikou

Cillóniz

2019

Expert Review of Anti-infective Therapy

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“…The SSUAD assay is ≥ 95% sensitive and specific for detecting PCV13 serotypes in patients with bacteremic or nonbacteremic radiographically-confirmed CAP when validated against typed, positive blood culture results from bacteremic pneumonia patients. [45][46][47] Thus, this validated, limit assay demonstrated much higher sensitivity than culture or BinaxNOW. [45][46][47] Early in 2018, estimates of the proportion of CAP caused by PCV13 serotypes in US adults from the CDC-funded EPIC study were published.…”

Section: Introductionmentioning

confidence: 92%

“…[45][46][47] Thus, this validated, limit assay demonstrated much higher sensitivity than culture or BinaxNOW. [45][46][47] Early in 2018, estimates of the proportion of CAP caused by PCV13 serotypes in US adults from the CDC-funded EPIC study were published. 47 The EPIC study prospectively enrolled immunocompetent adults hospitalized with CAP with the primary objective of determining pneumonia etiology.…”

Section: Introductionmentioning

confidence: 92%

“…[45][46][47] Early in 2018, estimates of the proportion of CAP caused by PCV13 serotypes in US adults from the CDC-funded EPIC study were published. 47 The EPIC study prospectively enrolled immunocompetent adults hospitalized with CAP with the primary objective of determining pneumonia etiology. PCV13 serotypes were detected in 6.3% of all CAP between July 2010 and June 2012 in the EPIC study based on culture and SSUAD.…”

Section: Introductionmentioning

confidence: 99%

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Decision-making for PCV in adults

Swerdlow

Istúriz

Jódar

2018

Human Vaccines & Immunotherapeutics

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Thirteen-valent pneumococcal conjugate vaccine (PCV13) was licensed in adults to address the unmet medical need of vaccine-type community acquired pneumonia (CAP) and the limitations of previous plain-polysaccharide vaccines. Since then, some have questioned the utility of adult PCV13 use, arguing that: i) high PCV13 uptake in young children would provide indirect effects that, by themselves, would sufficiently protect unvaccinated adults and ii) no data describing the real-world effectiveness of PCV13 use in adults, especially with immunocompromising conditions, exist. Even in countries like the United States where PCV13 has been routinely recommended for all adults aged ≥ 65 years, the recommendation is contingent on a re-evaluation to determine if continued use is needed in the context of a mature PCV13 pediatric immunization program. Emerging evidence, however, suggests that i) a meaningful burden of PCV13-type pneumococcal pneumonia still persists in adults at increased risk for pneumococcal disease, despite indirect effects from long-standing pediatric PCV13 use, ii) adult PCV13 use is effective and has reduced pneumococcal CAP, even in the elderly and those with chronic medical or immunocompromising conditionsand disease could come back if PCV13 were removed, and iii) ethical and pragmatic vaccine policy considerations support continued adult PCV13 use in countries that have already introduced the vaccine (eg, disparities in adult PCV13 uptake, confusion stemming from removing a previously-recommended vaccine for a non-safety-related concern, and the reality that next-generation PCVs are only a few years away). Together, these findings suggest that continued PCV13 vaccination in adults is needed to control vaccine-type CAP.

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“…9,10 Interestingly, in the latter study, additional use of a novel serotype-specific urine antigen detection assay, as opposed to the commercially available urine antigen detection test, increased the detection rate of pneumococcal cases from 4.4 to 9.7% overall. 16 Furthermore, an active surveillance study for pneumococcal CAP and invasive pneumococcal disease (IPD) was undertaken in adults hospitalized across five Canadian provinces from 2010 to 2013. 17 Diagnostic testing for pneumococcal CAP was undertaken using sputum and blood culture, a commercial pneumococcal urine antigen detection test and a serotype-specific pneumococcal urine antigen detection test.…”

mentioning

confidence: 99%

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

Feldman

Anderson

2020

Semin Respir Crit Care Med

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AbstractWith the notable exceptions of the United States and Canada in particular, the global burden of disease in adults due to invasive infection with the dangerous respiratory, bacterial pathogen, Streptococcus pneumoniae (pneumococcus) remains. This situation prevails despite the major successes of inclusion of polysaccharide conjugate vaccines (PCVs) in many national childhood immunization programs and associated herd protection in adults, as well as the availability of effective antimicrobial agents. Accurate assessment of the geographic variations in the prevalence of invasive pneumococcal disease (IPD) has, however, been somewhat impeded by the limitations imposed on the acquisition of reliable epidemiological data due to reliance on often insensitive, laboratory-based, pathogen identification procedures. This, in turn, may result in underestimation of the true burden of IPD and represents a primary focus of this review. Other priority topics include the role of PCVs in the changing epidemiology of IPD in adults worldwide, smoking as a risk factor not only in respect of increasing susceptibility for development of IPD, but also in promoting pneumococcal antibiotic resistance. The theme of pneumococcal antibiotic resistance has been expanded to include mechanisms of resistance to commonly used classes of antibiotics, specifically β-lactams, macrolides and fluoroquinolones, and, perhaps somewhat contentiously, the impact of resistance on treatment outcome. Finally, but no less importantly, the role of persistent antigenemia as a driver of a chronic, subclinical, systemic proinflammatory/procoagulant phenotype that may underpin the long-term sequelae and premature mortality of those adults who have recovered from an episode of IPD, is considered.

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Pneumococcal Community-Acquired Pneumonia Detected by Serotype-Specific Urinary Antigen Detection Assays

Abstract: Although restricted to the detection of only 13 serotypes, SSUAD testing substantially increased the detection of pneumococcal pneumonia among adults hospitalized with CAP.

Cited by 49 publications

References 39 publications

Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

Decision-making for PCV in adults

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

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