A 3-year prospective study of a urinary antigen-detection test for Streptococcus pneumoniae in community-acquired pneumonia: utility and clinical impact on the reported etiology

doi:10.1007/s10156-004-0351-1

Journal of Infection and Chemotherapy

Volume 10, Issue 6, 2004, Pages 359-363

https://doi.org/10.1007/s10156-004-0351-1 Get rights and content

Abstract

To evaluate the efficacy of a rapid immunochromatographic membrane test (ICT) for the detection of Streptococcus pneumoniae urinary antigen for diagnosing S. pneumoniae pneumonia, ICT was performed with urine samples using the Binax NOW Streptococcus pneumoniae kit at the time of admission. The results were compared with those from conventional microbiological studies. Three hundred and forty-nine adult patients with CAP who were admitted to the hospital were studied prospectively between February 2001 and January 2004. The ICT test was positive in 115 (33.0%) of 349 patients enrolled into the study and in 63 (75.9%) of 83 patients with pneumococcal pneumonia confirmed by conventional methods. The test revealed a sensitivity of 75.9% and a specificity of 94.0% with conventional microbiological criteria used as the reference standard. The positive predictive value was 91.3%, and the negative predictive value was 82.6%. The clinical features of 53 patients in whom ICT was positive and no pathogen was identified showed no significant difference from those of 83 patients who had pneumococcal pneumonia identified by conventional methods. The diagnostic yield of pneumococcal pneumonia was increased up to 38.9% using ICT combined with conventional methods. The Binax NOW ICT to detect S. pneumoniae urinary antigen is therefore a rapid and useful method for diagnosing pneumococcal pneumonia. Induction of ICT will prove the predominance of S. pneumoniae in the etiology of CAP.

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Cited by (107)

Comparative study of bacterial flora in bronchoalveolar lavage fluid of pneumonia patients based on their pneumonia subtypes and comorbidities using 16S ribosomal RNA gene analysis
2022, Journal of Infection and Chemotherapy
The culture method is the gold standard for identifying pathogenic bacteria in patients with pneumonia but often does not reflect the exact bacterial flora in pulmonary lesions of pneumonia, partly owing to easiness or difficulties in culturing certain bacterial species. We aimed to evaluate bacterial flora in bronchoalveolar lavage fluid (BALF) samples directly obtained from pneumonia lesions using 16S ribosomal RNA (rRNA) gene analysis to compare the results of the BALF culture method in each category of pneumonia.
Bacterial florae were detected by a combination of the culture method, and the clone library method using the 16S rRNA gene sequencing in BALF directly obtained from pneumonia lesions in pneumonia patients from April 2010 to March 2020 at the University of Occupational and Environmental Health, Japan, and affiliated hospitals. Clinical information of these patients was also collected, and lung microbiome was evaluated for each pneumonia category.
Among 294 pneumonia patients (120 with community-acquired pneumonia (CAP), 101 with healthcare-associated pneumonia (HCAP), and 73 with hospital-acquired pneumonia (HAP)), significantly higher percentages of obligate anaerobes were detected in CAP than in HCAP and HAP patients by the clone library method. Corynebacterium species were significantly highly detected in HAP patients and patients with cerebrovascular diseases than in patients without, and Streptococcus pneumoniae was frequently detected in patients with diabetes mellitus.
Obligate anaerobes may be underestimated in patients with CAP. Corynebacterium species should be regarded as the causative bacteria for pneumonia in patients with HAP and cerebrovascular diseases.
ARDS clinical practice guideline 2021
2022, Respiratory Investigation
Citation Excerpt :
Changes in clinical conditions (e.g., patient characteristics, testing characteristics and timing, pre-test probability, patient/medical staff values) may change the balance of effects and result in a different option being recommended. Pneumococcal urinary antigen testing (23 studies [36–58]: N = 10,900) had an integrated sensitivity of 0.65 (95% CI: 0.61–0.68) and integrated specificity of 0.91 (95% CI: 0.85–0.95). Sputum Gram staining (11 studies [55,59–68]: N = 1,794) had an integrated sensitivity of 0.69 (95% CI: 0.56–0.80) and integrated specificity of 0.91 (95% CI: 0.83–0.96).
The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021.
The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method.
Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO₂ (PaO₂) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D); we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D); we suggest against routinely implementing NO inhalation therapy (GRADE 2C); and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D).
This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jrs.or.jp/publication/jrs_guidelines/). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.
Predictors and usefulness of targeted therapy for pneumococcal community-acquired pneumonia diagnosed by the urinary antigen test: a prospective, observational cohort study
2021, Diagnostic Microbiology and Infectious Disease
Citation Excerpt :
Naturally, culture of respiratory specimens is the gold standard for the diagnosis of pneumococcal pneumonia, but the urinary antigen test (UAT) kit that detects the C-polysaccharide antigen of the cell wall of all types of S. pneumoniae for diagnosing pneumococcal pneumonia is widely used worldwide because of its simple procedure and rapid results (Werno and Murdoch, 2008; Blaschke, 2011). In addition, the specificity of the pneumococcal UAT (PUAT) was reported to be 90% to 100% (Rosón et al., 2004, Ishida et al., 2004; Molinos et al., 2015); therefore, it is very useful for making a definite diagnosis, and a positive PUAT could lead to targeted antibiotic therapy. However, some studies showed that only 17.7% to 35% of pneumococcal pneumonia patients with a positive UAT were treated by targeted antibiotic therapy in the real world (Kobashi et al., 2007; Sorde et al., 2011; Engel et al., 2013).
The aim of the present study was to investigate the predictors of targeted therapy (TT) for pneumococcal community-acquired pneumonia (PCAP) with a positive urinary antigen test (UAT) and compare the outcomes with those of nontargeted therapy. This prospective cohort study enrolled consecutive PCAP patients with a positive UAT who were hospitalized at Kurashiki Central Hospital from October 2010 to November 2019. A total of 286 patients were included. Of them, 56 patients (19.6%) were included in the TT group. On multivariate analysis, identification of Gram-positive diplococci by Gram stain (OR [95% CI]: 2.46 [1.32–4.63]) was a positive predictor, whereas aspiration pneumonia (0.17 [0.03–0.59]) and CURB-65 score (0.59 [0.42–0.81]) were negative predictors of TT. Initial treatment failure and 30-day mortality were not significantly different. The UAT is not used enough for TT, and TT for PCAP did not have worse outcomes.
Ameliorative effect of Albizia chinensis synthesized ZnO-NPs on Mycoplasma pneumoniae infected pneumonia mice model
2020, Microbial Pathogenesis
Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) among the children and adults that results upper and lower respiratory tract infections.
This study was aimed to inspect the ameliorative action of A. chinensis synthesized ZnONPs against M. pneumoniae infected pneumonia mice model.
ZnO NPs was synthesized from Albizia chinensis bark extract and characterized by UV–Vis spectroscopy, Fourier Transform Infrared (FTIR), Transmission Electron Microscopy (TEM), energy dispersive X-ray (EDX) and atomic force microscope (AFM) analyses. The antibacterial effectual of synthesized ZnONPs were examined against clinical pathogens. The pneumonia was induced to BALB/c mice via injecting the M. pneumoniae and treated with synthesized ZnONPs, followed by the total protein content, total cell counts and inflammatory mediators level was assessed in the BALF of experimental animals. The Histopathological investigation was done in the lung tissues of test animals.
The outcomes of this work revealed that the formulated ZnONPs was quasi-spherical, radial and cylindrical; the size was identified as 116.5 ± 27.45 nm in diameter. The in vitro antimicrobial potential of formulated ZnO-NPs displayed noticeable inhibitory capacity against the tested fungal and bacterial strains. The administration of synthesized ZnO-NPs in MP infected mice model has significantly reduced the levels of total protein, inflammatory cells, inflammatory cytokines such as IL-1, IL-6, IL-8, tumour necrosis factor-alpha (TNF-a) and transforming growth factor (TGF). Besides, the histopathological examination of MP infected mice lung tissue showed the cellular arrangements were effectively retained after administration of synthesized ZnO-NPs.
In conclusion, synthesized ZnO-NPs alleviate pneumonia progression via reducing the level of inflammatory cytokines and inflammatory cells in MP infected mice model.
Outbreaks of influenza B infection and pneumococcal pneumonia at a mental health facility in Japan
2017, Journal of Infection and Chemotherapy
Citation Excerpt :
Thus, to address the increasing number of people who are receiving care at home or in nursing homes, the Japanese Respiratory Society issued the Clinical Practice Guidelines for Nursing- and Healthcare-associated Pneumonia (NHCAP) [2]. In this context, Streptococcus pneumoniae is the most important pathogen for both community-acquired pneumonia and NHCAP among elderly patients [3]. Furthermore, S. pneumoniae was detected in sputum from 31.8% of patients with NHCAP [4], and outbreaks of pneumococcal pneumonia in nursing homes and care facilities have been sporadically reported in the US, Europe, and Japan [5,6].
Japan has an aging population and an increasing number of patients who reside in long-term care and mental health facilities. Both pneumococcal pneumonia and influenza B infection outbreaks have been observed in these populations, although no reports have described concurrent outbreaks of pneumococcal pneumonia and influenza B infection in these facilities.
Six patients and two staffs were initially diagnosed with influenza B infection at a mental health facility on March 14, 2015. By March 21, influenza B infection was diagnosed in 26 patients and 10 staff; all individuals received anti-influenza drugs. On March 19, two patients were diagnosed with pneumococcal pneumonia, and seven patients had developed pneumococcal pneumonia by March 24. Six of these seven patients also had influenza B infection. All individuals who developed pneumococcal pneumonia were hospitalized and treated using ampicillin/sulbactam at our hospital, and their symptoms subsequently subsided. Among the seven pneumococcal strains that were frozen and stored, two strains were type 3 and five strains were type 11A/E. Pulsed-field gel electrophoresis testing revealed that each of the serum types were from the same clone.
It appears that an outbreak of influenza B infection was followed by the spread of multi-clone pneumococcal pneumonia among elderly patients at a mental health facility. Therefore, it may be prudent to use vaccinations to prevent the spread of pneumococcal pneumonia among elderly patients and this diagnosis should be actively considered during outbreaks of influenza infection at elder care facilities.
Role of flexible bronchoscopy in non-resolving community-acquired pneumonia - a retrospective analysis
2017, Revista Portuguesa de Pneumologia (English Edition)

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Journal of Infection and Chemotherapy

Abstract

References (18)

Etiology of community-acquired pneumonia requiring hospitalization in Japan

Chest

The urinary antigen test for the diagnosis of pneumococcal pneumonia

Chest

Nonvalue of the initial microbiological studies in the management of nonsevere community-acquired pneumonia

Chest

Etiology of community-acquired pneumonia in hospitalized patients: a 3-year prospective study in Japan

Chest

Etiology and management of community-acquired pneumonia in Asia

Curr Opin Infect Dis

Evaluation of community-acquired pneumonia guidelines of the Japanese Respiratory Society: differentiation of atypical pneumonia and bacterial pneumonia

J Jpn Respir Soc

Detection of Streptococcus pneumoniae antigen by a rapid immunochromatographic assay in urine samples

Chest

A prediction rule to identify low-risk patients with community-acquired pneumonia

N Engl J Med

Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia

Clin Infect Dis

Cited by (107)

Comparative study of bacterial flora in bronchoalveolar lavage fluid of pneumonia patients based on their pneumonia subtypes and comorbidities using 16S ribosomal RNA gene analysis

ARDS clinical practice guideline 2021

Predictors and usefulness of targeted therapy for pneumococcal community-acquired pneumonia diagnosed by the urinary antigen test: a prospective, observational cohort study

Ameliorative effect of Albizia chinensis synthesized ZnO-NPs on Mycoplasma pneumoniae infected pneumonia mice model

Outbreaks of influenza B infection and pneumococcal pneumonia at a mental health facility in Japan

Role of flexible bronchoscopy in non-resolving community-acquired pneumonia - a retrospective analysis