scholarly journals Urinary antigen testing in community-acquired pneumonia: clinical utility, cost effectiveness and the impact on antibiotic treatment

Respirology ◽  
2018 ◽  
Vol 23 ◽  
pp. 188-189
Keyword(s):  
Cost Effectiveness ◽  
Antibiotic Treatment ◽  
Clinical Utility ◽  
Community Acquired Pneumonia ◽  
Urinary Antigen ◽  
Urinary Antigen Testing ◽  
Utility Cost ◽  
The Impact ◽  
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 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 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.

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

Evaluation of pneumococcal urinary antigen testing for respiratory tract infection investigations

2020 ◽  
Vol 50 (1) ◽  
pp. 57-62 ◽  
Author(s):  
F. Charton ◽  
P.L. Conan ◽  
H. Le Floch ◽  
O. Bylicki ◽  
W. Gaspard ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Urinary Antigen ◽  
Urinary Antigen Testing ◽  
Antigen Testing

scholarly journals Environmental Cultures and Hospital-Acquired Legionnaires' Disease: A 5-Year Prospective Study in 20 Hospitals in Catalonia, Spain

2004 ◽  
Vol 25 (12) ◽  
pp. 1072-1076 ◽  
Author(s):  
Miquel Sabrià ◽  
Josep M. Mòdol ◽  
Marian Garcia-Nuñez ◽  
Esteban Reynaga ◽  
Maria L. Pedro-Botet ◽  
...  
Keyword(s):  
Prospective Study ◽  
Potable Water ◽  
Environmental Study ◽  
Urinary Antigen ◽  
Hospital Acquired Pneumonia ◽  
Urinary Antigen Testing ◽  
Legionnaires Disease ◽  
Hospital Acquired ◽  
Antigen Testing

AbstractObjective:To determine whether environmental cultures forLegionellaincrease the index of suspicion for legionnaires' disease (LD).Design:Five-year prospective study.Setting:Twenty hospitals in Catalonia, Spain.Methods:From 1994 to 1996, the potable water systems of 20 hospitals in Catalonia were tested forLegionella, Cases of hospital-acquired LD and availability of an “in-house”Legionellatest in the previous 4 years were assessed. After the hospitals were informed of the results of their water cultures, a prospective 5-year-study was conducted focusing on the detection of new cases of nosocomial legionellosis and the availability and use of Legionella testing.Results:Before environmental cultures were started, only one hospital had conducted active surveillance of hospital-acquired pneumonia and usedLegionellatests includingLegionellaurinary antigen in all pneumonia cases. Only one other hospital had used the latter test at all. In six hospitals,Legionellatests had been completely unavailable. Cases of nosocomial LD had been diagnosed in the previous 4 years in only two hospitals. During prospective surveillance, 12 hospitals (60%) usedLegionellaurinary antigen testing in house and 11 (55%) found cases of nosocomial legionellosis, representing 64.7% (11 of 17) of those with positive water cultures. Hospitals with negative water cultures did not find nosocomial LD.Conclusions:The environmental study increased the index of suspicion for nosocomial LD. The number of cases of nosocomial LD increased significantly during the prospective follow-up period, and most hospitals began using theLegionellaurinary antigen test in their laboratories.

The impact of first Timing of antibiotics for community acquired pneumonia in emergency department

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Antibiotic Treatment ◽  
Relevant Literature ◽  
Severity Of Illness ◽  
Clinical Situation ◽  
Community Acquired Pneumonia ◽  
Antibiotic Administration ◽  
Eligibility Criteria ◽  
Antibiotic Overuse ◽  
The Impact

Background and objective: For patients with community-acquired pneumonia (CAP), reported associations between timing of the first dose of antibiotics and short-term mortality are inconsistent. To reduce the risks of antibiotic overuse in the emergency department, this summary of the relevant literature identified patients with CAP who benefit most from early antibiotic administration. Methods: A PubMed and Google Scholar search was performed for articles concerning the epidemiology, prognosis, diagnosis, and preliminary management of CAP. Results: Duplicate studies were eliminated and 370 citations were screened. Finally, 16 studies met the eligibility criteria. The review found that, in the presence of sepsis, antibiotics should not be delayed but administered as soon as possible. For patients with moderate-to-severe symptoms, antibiotics should be administered if a diagnosis of CAP is highly likely. For stable, non-critically ill patients with CAP, the timing of antibiotics remains unclear, but available evidence does not indicate strict requirements. For best quality of care, antibiotic timing whether rapid or delayed depends on the clinical situation. Conclusions: In suspected cases of pneumonia presenting in the emergency department, starting antibiotics early solely to conform to dogmatic guidelines within a rigid timeframe has led to unnecessary antibiotic treatment of uninfected patients, while the outcomes of patients with pneumonia have not improved. Since severity of illness is the key factor associated with poor outcomes in pneumonia, the timing of initial antibiotic treatment should be guided by the severity of symptoms.

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