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Urinary antigen detection test may guide diagnosis, treatment of CAP
Sorde R. Arch Intern Med. 2010. doi:10.1001/archinternmed.2010.347
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Diagnosis with a urinary antigen test was linked to a reduction in the spectrum of antibiotic therapy in nearly 10% of patients with community-acquired pneumonia, according to recently published study results.
The analysis involved 474 episodes of community-acquired pneumonia among patients from multiple sites in Spain. Streptococcus pneumoniae was the causative pathogen in 171 of those cases, according to the results.
The exclusive method of detecting community-acquired pneumonia was urinary antigen test in 75 of cases. A pathogen other than S. pneumoniae caused community-acquired pneumonia in 69 cases.
The test had a 96% specificity rate, a positive predictive value that ranged from 88.8% to 96.5% and a positive likelihood ratio that ranged from 14.6 to 19.9. Forty-one patients received a reduced spectrum of antibiotics as a result of a clinician using the urinary antigen test.
All patients receiving a reduced antibiotic regimen were cured, according to the researchers. “Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test,” they wrote.
The pneumococcal urinary antigen test may allow clinicians to optimize antimicrobial therapy and maintain strong clinical outcomes, the researchers concluded.
The aim of the trial was to assess the usefulness of the pneumococcal antigen test in detecting community-acquired pneumonia and guiding antimicrobial therapy in patients hospitalized with the infection.
The prospective trial of all adults hospitalized with community-acquired pneumonia at the participating facilities in Spain was conducted from February 2007 to January 2008. Primary outcome measures included the sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of the urinary antigen test.
Isolation in blood or pleural fluid — the defined definite diagnosis — and isolation in sputum — the defined probable diagnosis — were the gold standards used for all diagnoses. Analyses of antibiotic modifications, complications and mortality also were conducted.