scholarly journals Pneumococcal and Legionella Urinary Antigen Tests in Community-acquired Pneumonia: Prospective Evaluation of Indications for Testing

2018 ◽  
Vol 68 (12) ◽  
pp. 2026-2033 ◽  
Author(s):  
Shawna Bellew ◽  
Carlos G Grijalva ◽  
Derek J Williams ◽  
Evan J Anderson ◽  
Richard G Wunderink ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Legionella Pneumophila ◽  
Community Acquired Pneumonia ◽  
Urinary Antigen ◽  
Prospective Surveillance ◽  
Expert Opinions ◽  
Urinary Antigen Testing ◽  
Antigen Tests ◽  
Individual Criterion ◽  
Antigen Testing

Abstract Background Adult, community-acquired pneumonia (CAP) guidelines from the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) include indications for urinary antigen tests (UATs) for Streptococcus pneumoniae (SP) and Legionella pneumophila (LP). These recommendations were based on expert opinions and have not been rigorously evaluated. Methods We used data from a multicenter, prospective, surveillance study of adults hospitalized with CAP to evaluate the sensitivity and specificity of the IDSA/ATS UAT indications for identifying patients who test positive. SP and LP UATs were completed on all included patients. Separate analyses were completed for SP and LP, using 2-by-2 contingency tables, comparing the IDSA/ATS indications (UAT recommended vs not recommended) and UAT results (positive vs negative). Additionally, logistic regression was used to evaluate the association of each individual criterion in the IDSA/ATS indications with positive UAT results. Results Among 1941 patients, UATs were positive for SP in 81 (4.2%) and for LP in 32 (1.6%). IDSA/ATS indications had 61% sensitivity (95% confidence interval [CI] 49–71%) and 39% specificity (95% CI 37–41%) for SP, and 63% sensitivity (95% CI 44–79%) and 35% specificity (95% CI 33–37%) for LP. No clinical characteristics were strongly associated with positive SP UATs, while features associated with positive LP UATs were hyponatremia, fever, diarrhea, and recent travel. Conclusions Recommended indications for SP and LP urinary antigen testing in the IDSA/ATS CAP guidelines have poor sensitivity and specificity for identifying patients with positive tests; future CAP guidelines should consider other strategies for determining which patients should undergo urinary antigen testing.

scholarly journals Legionella pneumonia presenting with bilateral flank pain, hyponatraemia and acute renal failure

2013 ◽  
Vol 5 (6) ◽  
pp. 96
Author(s):  
Celia Birkin ◽  
Chandra Shekhar Biyani ◽  
Anthony J. Browning
Keyword(s):  
Gastrointestinal Symptoms ◽  
Community Acquired Pneumonia ◽  
Flank Pain ◽  
High Fever ◽  
Urinary Antigen ◽  
Legionella Pneumonia ◽  
Urinary Antigen Testing ◽  
Legionella Species ◽  
Legionnaires Disease ◽  
Antigen Testing

Legionnaires’ disease (LD) is an often overlooked but a possiblecause of sporadic community acquired pneumonia. High fever,cough and gastrointestinal symptoms are non-specific symptoms.Hyponatremia is more common in LD than pneumonia linkedwith other causes. A definitive diagnosis is usually confirmed byculture, urinary antigen testing for Legionella species. Macolideor quinolone antibiotic is the treatment of choice. We describe acase of Legionella pneumonia presenting with high fever, bilateralflank pain and oliguria. It is important for clinicians to be awareof this diagnosis when managing patients with flank pain. Thecase highlights the problems in differentiating LD from renal colicand the importance of proper history, physical examination withlaboratory tests for appropriate management.

scholarly journals Healthcare-associated Legionnaires’ disease: Limitations of surveillance definitions and importance of epidemiologic investigation

2017 ◽  
Vol 18 (6) ◽  
pp. 307-310 ◽  
Author(s):  
Laila M Castellino ◽  
Shantini D Gamage ◽  
Patti V Hoffman ◽  
Stephen M Kralovic ◽  
Mark Holodniy ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Sequence Type ◽  
Significant Morbidity ◽  
Urinary Antigen ◽  
Epidemiologic Investigation ◽  
Urinary Antigen Testing ◽  
Legionnaires Disease ◽  
Healthcare Associated ◽  
Antigen Testing

Healthcare-associated Legionnaires’ disease (HCA LD) causes significant morbidity and mortality, with varying guidance on prevention. We describe the evaluation of a case of possible HCA LD and note the pitfalls of relying solely on an epidemiologic definition for association of a case with a facility. Our detailed investigation led to the identification of a new Legionella pneumophila serogroup 1 sequence type, confirmed a healthcare association and helped build the framework for our ongoing preventive efforts. Our experience highlights the role of routine environmental cultures in the assessment of risk for a given facility. As clinicians increasingly rely on urinary antigen testing for the detection of L. pneumophila, our investigation emphasises the importance of clinical cultures in an epidemiologic investigation.

scholarly journals 68. Impact of Streptococcus pneumoniae Urinary Antigen Testing in Patients with Community-Acquired Pneumonia Admitted within a Large Academic Medical System

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S152-S152
Author(s):  
Adam Greenfield ◽  
Kassandra L Marsh ◽  
Justin Siegfried ◽  
Ioannis Zacharioudakis ◽  
Nabeela Ahmed ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Diagnostic Testing ◽  
Pneumonia Severity Index ◽  
Severity Of Illness ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Urinary Antigen ◽  
Urinary Antigen Testing ◽  
Antigen Testing

Abstract Background Limited data support the use of pneumococcal urinary antigen testing (PUAT) for patients admitted with community-acquired pneumonia (CAP) as a stewardship tool to curtail the use of broad-spectrum antimicrobials. At NYULH, CAP guidelines and admission order set were developed to standardize diagnostic testing, including PUAT. In this study we describe patients with positive versus negative PUAT and evaluate de-escalation and patients’ outcomes. Methods This was a retrospective study of adults admitted with diagnosis of CAP between January-December 2019 who had a PUAT performed. The primary outcome was incidence and timing of de-escalation of antimicrobials following PUAT result. Among patients with a positive PUAT we compared hospital length of stay (LOS), incidence of Clostridioides difficile infection (CDI), infection-related readmission within 30 days, and in-hospital mortality among those who were de-escalated versus those who were not de-escalated/required escalation. Results We evaluated 910 patients, of which 121 (13.3%) were PUAT positive. No difference in baseline characteristics, including severity of illness as represented by the Pneumonia Severity Index (97 [IQR 76-117] vs 89 [IQR 67-115], p=0.083) and Charlson Comorbidity Index, were observed between PUAT positive and negative groups. Time to PUAT testing occurred shortly after presentation to the hospital in both cohorts (16h [IQR 16-27] vs 13h [IQR 8-22], p=0.140). Initial de-escalation occurred in 97/117 (82.9%) and 629/775 (81.2%) of PUAT positive and negative patients, respectively (p = 0.749). Median time to de-escalation was shorter in the PUAT positive cohort (1 [IQR 0-2] vs 1 [IQR 1-2] day, p = 0.01). Among the PUAT positive group, hospital LOS stay was shorter in patients who were de-escalated compared to those who were not de-escalated/required escalation (6 days [IQR 4-10] vs 8 days [IQR 7-12], p=0.0005) with no difference in the incidence of CDI (2 [2.1%] vs 1 [3.7%], p=0.535), in-hospital mortality (4 [4.3%] vs 3 [11.1%], p=0.185), or 30-day infection-related readmission (2 [2.1%] vs 1 [3.7%], p=0.535). Conclusion PUAT positivity resulted in quicker time to targeted therapy for CAP. Among patients with a positive PUAT, initial de-escalation of antimicrobials did not lead to worse patient outcomes. Disclosures All Authors: No reported disclosures

Urinary antigen testing in community-acquired pneumonia in adults: an update

2019 ◽  
Vol 17 (2) ◽  
pp. 107-115 ◽  
Author(s):  
Diego Viasus ◽  
Laura Calatayud ◽  
María V. McBrown ◽  
Carmen Ardanuy ◽  
Jordi Carratalà
Keyword(s):  
Community Acquired Pneumonia ◽  
Urinary Antigen ◽  
Urinary Antigen Testing ◽  
Antigen Testing

scholarly journals 94. Appropriate Urine Legionella Antigen Testing: A Step Towards Diagnostic Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S62-S63
Author(s):  
Faran Ahmad ◽  
Moeed Ahmed ◽  
Manasa Velagapudi ◽  
Marvin J Bittner
Keyword(s):  
Legionella Pneumophila ◽  
Medical Center ◽  
Financial Burden ◽  
Severe Pneumonia ◽  
Retrospective Chart Review ◽  
Community Acquired Pneumonia ◽  
Admission Diagnosis ◽  
Institutional Review ◽  
Antigen Tests ◽  
Antigen Testing

Abstract Background Pneumonia is a leading cause of sepsis and hospitalization. Infectious Diseases Society of America and American Thoracic Society (IDSA/ATS) published 2019 practice guidelines for community-acquired pneumonia (CAP), recommending urinary antigen testing (UAT) for Legionella pneumophila (LP) only in patients with severe pneumonia or having epidemiological risk factors. In the last 20 years, there has been no Legionella outbreak in Nebraska. Currently, the urine antigen test is considered based on the discretion of the ordering provider. However, this usually results in over-utilization of the test and associated financial burden. Methods Retrospective chart review of patients admitted to Bergan Mercy Medical Center, Creighton University, Omaha with the admission diagnosis of community-acquired pneumonia in the year 2019, by using electronic medical records. The charts were reviewed for baseline characteristics, admission diagnoses, and clinical outcomes. The project was submitted to and reviewed by the institutional review board. Results From January to December 2019, 4738 patients were admitted to the general medical floors with the diagnosis of community-acquired pneumonia. Among those patients, 826 patients (17.43%) had urine Legionella antigen tests done, only 11 (0.23%) were tested positive. Moreover, 140 patients (2.95%) had urine Legionella antigen tests in the absence of a documented diagnosis of community-acquired pneumonia. Patients admitted to intensive care units were not included in the study as guidelines do not restrict from ordering urine Legionella tests in patients with severe sepsis secondary to community-acquired pneumonia. Conclusion A diagnostic stewardship approach should be considered for urine Legionella antigen testing. Moreover, such a retrospective review provides an opportunity for quality improvement initiatives at the academic medical facilities with lower Legionella outbreaks. Disclosures All Authors: No reported disclosures

Urinary antigen tests and the investigation of suspected community acquired pneumonia

2019 ◽  
Vol 79 (4) ◽  
pp. 389-399
Author(s):  
Sakib Rokadiya ◽  
Poppy Denniston ◽  
William Ricketts ◽  
Jonathan Lambourne
Keyword(s):  
Community Acquired Pneumonia ◽  
Urinary Antigen ◽  
Antigen Tests

A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System

1998 ◽  
Vol 19 (12) ◽  
pp. 905-910 ◽  
Author(s):  
Lisa A. Lepine ◽  
Daniel B. Jernigan ◽  
Jay C. Butler ◽  
Janet M. Pruckler ◽  
Robert F. Benson ◽  
...  
Keyword(s):  
Plumbing System ◽  
Urinary Antigen ◽  
Urinary Antigen Testing ◽  
Legionnaires Disease ◽  
Antigen Testing

scholarly journals Evaluation of the Sofia S. pneumoniae FIA for Detection of Pneumococcal Antigen in Patients with Bloodstream Infection

2019 ◽  
Vol 57 (8) ◽  
Author(s):  
Emma Olofsson ◽  
Volkan Özenci ◽  
Simon Athlin
Keyword(s):  
Bloodstream Infection ◽  
Legionella Pneumophila ◽  
Pneumococcal Infection ◽  
Test Results ◽  
Urinary Antigen ◽  
Content Type ◽  
Pneumococcal Antigen ◽  
Automatic Reading ◽  
Antigen Tests ◽  
Test Result

ABSTRACT The usefulness of pneumococcal urinary antigen tests (UATs) in severe pneumococcal infection relies heavily on the performance in bacteremic patients. Fluorescence technology and automatic reading of test results may improve UAT performance. We evaluated the automatically read Sofia S. pneumoniae FIA for diagnosing pneumococcal bloodstream infection (BSI) in hospitalized adult patients. First, the Sofia FIA was evaluated on 97 patients with pneumococcal (n = 47) and nonpneumococcal (n = 50) BSI and compared with results by the visually read BinaxNOW S. pneumoniae immunochromatographic test (ICT) and ImmuView S. pneumoniae and Legionella pneumophila ICT. In four cases (4.1%), the Sofia FIA showed invalid test results, three of which showed invalid results by the ImmuView ICT previously. Based on 93 valid cases, the Sofia FIA showed similar sensitivity (for both comparisons: 68% versus 62%; P = 0.45) and specificity (for both comparisons: 91% versus 93%; P = 1.00) as the visually read UATs. Second, the Sofia FIA was prospectively evaluated on 82 consecutive nonfrozen urine samples, detecting pneumococcal antigen in 10 of 14 (sensitivity, 71%) pneumococcal BSI patients, similarly to the visually and automatically read BinaxNOW ICT (both 12 of 14; sensitivity, 86%; P = 0.50). Of five nonpneumococcal BSI cases, the Sofia FIA showed an invalid test result in one case, but no positive UAT results were obtained. Thus, the sensitivity and specificity of the Sofia FIA were similar to the performance rates of other UATs in patients with BSI, but invalid test results are of concern for the usefulness in pneumococcal BSI.

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