Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

Abstract

When its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes.

Systematic Review and Meta-Analysis of a Urine-Based Pneumococcal Antigen Test for Diagnosis of Community-Acquired Pneumonia Caused by Streptococcus pneumoniae

“…Two randomized controlled trials (51,52) and two observational studies (24,33) have examined the impact of use of BinaxNOW-SP in treatment decision-making on outcomes in hospitalized patients. In the randomized controlled trials, patients were randomized to empirical or targeted therapy, and those receiving targeted therapy who tested positive with BinaxNOW-SP received therapy specific for S. pneumoniae.…”

Randomised controlled trial and health economic evaluation of the impact of diagnostic testing for influenza, respiratory syncytial virus and Streptococcus pneumoniae infection on the management of acute admissions in the elderly and high-risk 18- to 64-year-olds

“…The BinaxNOW POCT has a high specificity, in excess of 90%, and contributed to a reduction in the spectrum of antibiotic cover of 41 of 474 episodes of CAP in one recent study. 161 In comparison with blood and sputum cultures, the pneumococcal urinary antigen test has advantages of being a simple and rapid method with visually detectable results (see Chapter 7), providing speedy diagnosis without any additional equipment or reagents in a clinic or triage setting; is non-invasive; positive results persist over a period of days and occur despite treatment with antibiotics; and the test has high sensitivity and specificity. However, a negative result cannot rule out pneumococcal infection.…”

“…The 25 patients assigned to targeted treatment showed a statistically significant higher risk of clinical relapse compared with the remaining population (12% vs. 3%, p = 0.04). However, Sordé et al 161 reduced the spectrum of antibiotics in 41 patients with positive antigen tests; pneumonia was cured in all patients. Factors for further consideration include the proportion of patients with CAP who have S. pneumoniae infection, the sensitivity and costs of the test, failure rate of 'optimised' antimicrobial therapy (i.e.…”

“…We note that at least three investigators have used the results of pneumococcal antigen test (exclusively) prospectively to target narrow-spectrum β-lactam treatment in CAP, with inconsistent results. 161,239,240 Guchev et al 239 did a non-randomised study that evaluated a targeted approach to antibiotic therapy, based on the results of the pneumococcal urinary antigen test in young military recruits patients with non-severe pneumonia. Twenty-two per cent of patients with CAP had positive urinary tests and all were treated with oral amoxicillin.…”

Clinical Usefulness of Streptococcus pneumoniae Urinary Antigen in Patients Hospitalized with Non-Nosocomial Pneumonia

“…The clinical usefulness of the pneumococcal urinary antigen (PUatg) is not totally established; therefore, the current recommendations don't clearly define the situations in which the test should be obtained [12][13][14] .…”