Pneumococcal urinary antigen test use in diagnosis and treatment of pneumonia in seven Utah hospitals

Abstract

The pneumocococcal urine antigen test increases specific microbiological diagnosis over conventional culture methods in pneumonia patients. Data are limited regarding its yield and effect on antibiotic prescribing among patients with community-onset pneumonia in clinical practice.We performed a secondary analysis of 2837 emergency department patients admitted to seven Utah hospitals over 2 years with international diagnostic codes version 9 codes and radiographic evidence of pneumonia.Mean age was 64.2 years, 47.2% were male and all-cause 30-day mortality was 9.6%. Urinary antigen testing was performed in 1110 (39%) patients yielding 134 (12%) positives. Intensive care unit patients were more likely to undergo testing, and have a positive result (15% versus 8.8% for ward patients; p<0.01). Patients with risk factors for healthcare-associated pneumonia had fewer urinary antigen tests performed, but 8.4% were positive. Physicians changed to targeted antibiotic therapy in 20 (15%) patients, de-escalated antibiotic therapy in 76 patients (57%). In 38 (28%) patients, antibiotics were not changed. Only one patient changed to targeted therapy suffered clinical relapse. Length of stay and mortality were lower in patients receiving targeted therapy.Pneumococcal urinary antigen testing is an inexpensive, noninvasive test that favourably influenced antibiotic prescribing in a “real world”, multi-hospital observational study.

Performance of pneumococcal urinary antigen test in patients with community-onset pneumonia: a propensity score-matching study

“…Although a previous study revealed that the PUAT was more sensitive in patients with high-risk pneumonia as compared to those without (94% vs. 63%, p < 0.001) [25], the rate of severe pneumonia in our study was similar between both groups (16.0% vs. 15.1%, p = 0.773). And, while a recent multicenter USA study reported that patients with HCAP were less likely to have positive PUAT results than those with CAP [10], there were no differences in positive PUAT results between the CAP and HCAP groups in our study.…”

“…To date, the clinical benefits derived from the results of PUAT have not been fully established [10]. Thus, the aim of our study was to investigate the diagnostic performances of the PUAT, and the association between the results of PUAT and clinical outcomes in patients with CO-pneumonia.…”

Determinants of empirical antipseudomonal antibiotic prescription for adults with pneumonia in the emergency department

“…Another interesting finding was the association with negative pneumococcal urine antigen tests. The presence of a positive pneumococcal urine antigen test is indicative of S pneumoniae etiology, but therapy is based on the result in fewer than 15% of cases [30]. Although outcomes with fluoroquinolones and β-lactams seem to be similar, it is less clear whether a β lactam/ macrolide combination is superior to fluoroquinolone monotherapy; the findings are conflicting and the data in patients with severe disease are insufficient to draw conclusions [31].…”

Community-acquired pneumonia: Strategies for triage and treatment

“…15 The pneumococcal urinary antigen has a similarly reliable negative predictive value and can also be used to de-escalate empiric antimicrobial therapy. 16 Should microbiologic evaluation fail to identify a causative organism, the patient's individual risk factors as listed above must be considered in de-escalating therapy to a fi nal regimen with coverage for MRSA, Pseudomonas aeruginosa, or atypical pathogens as indicated. Pseudomonal pneumonia has been associated with higher risk of mortality and relapse than pneumonia caused by other pathogens.…”