Diagnostic, therapeutic and economic consequences of a positive urinary antigen test for<i>Legionella</i>spp. in patients admitted with community-acquired pneumonia: a 7-year retrospective evaluation

Engel, Madelon F; Manen, Labrinus van; Hoepelman, Andy I. M.; Thijsen, Steven; Oosterheert, Jan Jelrik

doi:10.1136/jclinpath-2012-201209

Cited by 19 publications

(21 citation statements)

References 18 publications

(19 reference statements)

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“…However, sensitivities among commercially available tests for non-Lp1 LD are highly variable and generally much lower than those for Lp1-associated disease when assayed with urine from patients with confirmed LD (267,(270)(271)(272)(273)(274)(275). Importantly, the sensitivities of most similar-format UATs are generally equivalent, regardless of the manufacturer (267)(268)(269)(276)(277)(278)(279), and they all allow for rapid assessment and patient treatment (280)(281)(282), unlike culture or serology, which may take days to weeks (139). Overall, the card-based ICT is a rapid, simple, qualitative assay for basic laboratory or POC use, while the EIA format is quantitative, may offer comparatively higher sensitivity and specificity, and is more suited for larger clinical, reference, or research laboratories (283).…”

Section: Urinary Antigen Testmentioning

confidence: 99%

“…Over the past 30 years, the development and implementation of UATs have greatly benefited LD patients by significantly improving diagnosis rates and thus allowing timely treatment (146,257,280). The LD-associated mortality rate decreased dramatically (ϳ77%) in the United States from 1985 to 2009, along with a rapid increase in DFA and culture-based detection in the early 1980s, the mainstream introduction of the Legionella UAT (in the 1980s and 1990s), and updated guidelines (in the 1990s) by the American Thoracic Society and the Infectious Diseases Society of America for coverage of Legionella in empirical antibiotic therapy for CAP (15,125,284,285).…”

Section: Urinary Antigen Testmentioning

confidence: 99%

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Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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SUMMARY Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

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Section: Urinary Antigen Testmentioning

confidence: 99%

Section: Urinary Antigen Testmentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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“…Legionella pneumonia usually progresses to severe condition. Almost 50% of the hospitalized patients due to Legionella infections require ICU admission, and the mortality is up to 5%‐30% . Susceptible populations include the elderly, males, smokers, individuals with chronic underlying cardiac or pulmonary diseases, diabetes mellitus, malignant tumour, immunosuppression and use of tumour necrosis factor‐α antagonists .…”

Section: Section 7 Unusual Types Of Capmentioning

confidence: 99%

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Cao

Huang

She

et al. 2017

Clinical Respiratory J

177

181

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Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.

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“…No obstante, comparte los mismos inconvenientes que hemos mencionado para el antígeno de neumococo y el balance coste-beneficio resulta también desfavorable 51 . Por tanto, en algunos centros se reserva para aquellos pacientes con criterios sugestivos de infección por Legionella.…”

Section: Estudios Microbiológicosunclassified

Neumonía adquirida en la comunidad

Falguera

Ramírez

2015

Revista Clínica Española

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Diagnostic, therapeutic and economic consequences of a positive urinary antigen test forLegionellaspp. in patients admitted with community-acquired pneumonia: a 7-year retrospective evaluation

Abstract: Timely LUAT use in accordance with current guidelines allows early detection and treatment of CAP caused by Legionella spp. at considerable expense.

Cited by 19 publications

References 18 publications

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Neumonía adquirida en la comunidad

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