Pneumococcal Urinary Antigen Test Use in Diagnosis and Treatment of Pneumonia in Seven Utah Hospitals

Overview

Journal ERJ Open Res

Specialty Pulmonary Medicine

Date 2017 Jan 6

PMID 28053969

Citations 14

Authors

Devin M West

Lindsay M McCauley

Jeffrey S Sorensen

Al R Jephson

Nathan C Dean

Affiliations

Soon will be listed here.

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% 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.

Citing Articles

Things We Do for No Reason - Ordering Urinary Antigen in Patients With Community-Acquired Pneumonia.

Davis M, McCreary E, Trzebucki A Open Forum Infect Dis. 2024; 11(3):ofae089.

PMID: 38524231 PMC: 10959547. DOI: 10.1093/ofid/ofae089.

Derivation and external validation of a prediction model for pneumococcal urinary antigen test positivity in patients with community-acquired pneumonia.

Kim P, Rothberg M, Nowacki A, Yu P, Gugliotti D, Deshpande A Antimicrob Steward Healthc Epidemiol. 2023; 3(1):e166.

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A case report of disseminated complicated by infective endocarditis, septic arthritis and epidural abscess in an immunocompetent patient.

Dean K, Koirala A, Samarasekara H Access Microbiol. 2023; 5(7).

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Urinary Antigen Testing for Respiratory Infections: Current Perspectives on Utility and Limitations.

Kim P, Deshpande A, Rothberg M Infect Drug Resist. 2022; 15:2219-2228.

PMID: 35510157 PMC: 9058651. DOI: 10.2147/IDR.S321168.

Impact of Urinary Antigen Testing in Patients With Community-Acquired Pneumonia Admitted Within a Large Academic Health System.

Greenfield A, Marsh K, Siegfried J, Zacharioudakis I, Ahmed N, Decano A Open Forum Infect Dis. 2022; 9(1):ofab522.

PMID: 34993258 PMC: 8717893. DOI: 10.1093/ofid/ofab522.

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