Novel Approaches to the Identification of<i>Streptococcus pneumoniae</i>as the Cause of Community‐Acquired Pneumonia

Klugman, Keith P.; Madhi, Shabir А.; Albrich, Werner C.

doi:10.1086/591405

Cited by 91 publications

(65 citation statements)

References 53 publications

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“…5,19,20 While there are no data on its contribution to lower respiratory infection in these children, carriage of non-encapsulated Haemophilus influenzae is as high as 100% by 120 days of age. 21 Data from studies published since this study was conducted suggest that the WHO definition substantially underestimates the vaccine-preventable proportion of pneumonia cases and that additional clinical data such as cross-reactive protein values may be important, [22][23][24] although the latter may be population-dependent. In a subanalysis of data from the phase III clinical trial of the 9-valent pneumococcal conjugate vaccine in the Gambia, cross-reactive protein values did not improve estimates of vaccine efficacy or vaccineattributable reduction in incidence.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in Indigenous infants in Australia

O'Grady

Carlin

Chang

et al. 2010

Bull World Health Org

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Section: Discussionmentioning

confidence: 99%

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in Indigenous infants in Australia

O'Grady

Carlin

Chang

et al. 2010

Bull World Health Org

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“…We excluded studies that had a case-control design that used patients without CAP as controls or that predominately or exclusively included children, patients with nosocomial pneumonia, or outpatients. The BinaxNOW-SP test performs poorly with children because of their high level of asymptomatic nasal carriage of S. pneumoniae (14). We did not exclude studies with patients with HIV, AIDS, or other forms of immunosuppression, as BinaxNOW-SP measures a bacterial coat protein, the presence of which does not depend upon the patient mounting an immune response.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2013

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Standard culture methods for diagnosis of Streptococcus pneumoniae pneumonia take at least 24 h. The BinaxNOW urine-based test for S. pneumoniae (BinaxNOW-SP) takes only 15 min to conduct, potentially enabling earlier diagnosis and targeted treatment. This study was conducted to assess whether the use of BinaxNOW-SP at the time of hospital admission would provide adequate sensitivity and specificity for diagnosis of community-acquired pneumonia (CAP) in adult patients. We searched PubMed, EMBASE/OVID, Cochrane Collaboration, Centre for Reviews and Dissemination, INAHTA, and CADTH for diagnostic or etiologic studies of hospitalized predominately adult patients with clinically defined CAP that reported the diagnostic performance of BinaxNOW-SP versus cultures. Two authors independently extracted study details and diagnostic two-by-two tables. We found that 27 studies met our inclusion criteria, and three different reference standards were used between them. A bivariate meta-analysis of 12 studies using a composite of culture tests as the reference standard estimated the sensitivity of BinaxNOW-SP as 68.5% (95% credibility interval [CrI], 62.6% to 74.2%) and specificity as 84.2% (95% CrI, 77.5% to 89.3%). A meta-analysis of all 27 studies, adjusting for the imperfect and variable nature of the reference standard, gave a higher sensitivity of 74.0% (CrI, 66.6% to 82·3%) and specificity of 97.2% (CrI, 92.7% to 99.8%). The analysis showed substantial heterogeneity across studies, which did not decrease with adjustment for covariates. We concluded that the higher pooled sensitivity (compared to culture) and high specificity of BinaxNOW-SP suggest it would be a useful addition to the diagnostic workup for community-acquired pneumonia. More research is needed regarding the impact of BinaxNOW-SP on clinical practice. Streptococcus pneumoniae pneumonia is believed to be the most common cause of community-acquired pneumonia (CAP) in adults, which in turn is the most common infection-related cause of death in developed countries (1). Diagnosis is usually established by observation of S. pneumoniae in a Gram-stained sputum sample or growth of S. pneumoniae in a culture of blood, sputum, pleural fluid, or other respiratory sample. Although highly specific, culturing is known to be insensitive, with diagnostic yields reported to be Ͻ30% for blood culture (2-7) and 57% for sputum culture (the latter in patients who had an etiologic diagnosis established) (8). Cultures also require 24 h or more to produce results. In the absence of a reliable rapid test for pneumonia caused by S. pneumoniae, initial treatment of pneumonia must be empirical, based upon knowledge of local pathogens, patient risk factors and comorbidities, and severity of presentation (7). Empirical therapy is generally effective (7), but there is increasing interest in improved targeting of antibiotics, due to the understanding that this may decrease the community prevalence of antibiotic-resistant bacteria and individual risks of antibiotic-associated Clostridium ...

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“…lungs themselves are invasive and rarely performed. There is also a paucity of diagnostic laboratories in developing countries and a lack of utilization of the meagre resources available in those countries [5,6]. The millennium development goal 4, which aims to reduce the infant mortality rate (IMR) by two-thirds to under 40 deaths per thousand live births globally by 2015, is dependent on interventions to reduce pneumonia deaths, as the fraction of pneumonia deaths increases with increasing IMR [1,7], but the contribution of the pneumococcus to that burden cannot be determined because of the insensitivity of these current diagnostic tests.…”

Section: The Clinical Spectrum and Burden Of Pneumococcal Diseasementioning

confidence: 99%

Contribution of vaccines to our understanding of pneumococcal disease

Klugman

2011

Phil. Trans. R. Soc. B

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Pneumonia is the leading cause of mortality in children in developing countries and is also the leading infectious cause of death in adults. The most important cause of pneumonia is the Gram-positive bacterial pathogen, Streptococcus pneumoniae, also known as the pneumococcus. It has thus become the leading vaccine-preventable cause of death and is a successful and diverse human pathogen. The development of conjugate pneumococcal vaccines has made possible the prevention of pneumococcal disease in infants, but has also elucidated aspects of pneumococcal biology in a number of ways. Use of the vaccine as a probe has increased our understanding of the burden of pneumococcal disease in children globally. Vaccination has also elucidated the clinical spectrum of vaccine-preventable pneumococcal infections; the identification of a biological niche for multiple pneumococcal serotypes in carriage and the differential invasiveness of pneumococcal serotypes; the impact of pneumococcal transmission among children on disease burden in adults; the role of carriage as a precursor to pneumonia; the plasticity of a naturally transformable pathogen to respond to selective pressure through capsular switching and the accumulation of antibioticresistance determinants; and the role of pneumococcal infections in hospitalization and mortality associated with respiratory viral infections, including both seasonal and pandemic influenza. Finally, there has been a recent demonstration that pneumococcal pneumonia in children may be an important cause of hospitalization for those with underlying tuberculosis.

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Novel Approaches to the Identification ofStreptococcus pneumoniaeas the Cause of Community‐Acquired Pneumonia

Cited by 91 publications

References 53 publications

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in Indigenous infants in Australia

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in Indigenous infants in Australia

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

Contribution of vaccines to our understanding of pneumococcal disease

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