Sordé Roger, Falcó Vicenç, Lowak Michael, Domingo Eva, Ferrer Adelaida, Burgos Joaquin, Puig Mireia, Cabral Evelyn, Len Oscar, Pahissa Albert
Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
Arch Intern Med. 2011 Jan 24;171(2):166-72. doi: 10.1001/archinternmed.2010.347. Epub 2010 Sep 27.
The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP.
A prospective study of all adults hospitalized with CAP was performed from February 2007 through January 2008. To evaluate the accuracy of the test, we calculated its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The gold standard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid (definite diagnosis) and isolation in sputum (probable diagnosis). Antibiotic modifications, complications, and mortality were analyzed.
A total of 474 episodes of CAP were included. Streptococcus pneumoniae was the causative pathogen in 171 cases (36.1%). It was detected exclusively by urinary antigen test in 75 cases (43.8%). Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae. Specificity was 96%, positive predictive value ranged from 88.8% to 96.5%, and the positive likelihood ratio ranged from 14.6 to 19.9. The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients. Pneumonia was cured in all of them. Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test.
When its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes.
肺炎球菌尿抗原检测在成人社区获得性肺炎（CAP）治疗中的作用尚未明确界定。我们评估了肺炎球菌尿抗原检测在CAP住院患者诊断及抗菌治疗指导方面的效用。
对2007年2月至2008年1月期间所有因CAP住院的成人患者进行了一项前瞻性研究。为评估该检测的准确性，我们计算了其敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比。用于诊断肺炎球菌肺炎的金标准是在血液或胸腔积液中分离出病原体（确诊）以及在痰液中分离出病原体（疑似诊断）。分析了抗生素调整、并发症和死亡率。
共纳入474例CAP病例。肺炎链球菌是171例（36.1%）病例的致病病原体。其中75例（43.8%）仅通过尿抗原检测被发现。69例患者的CAP由肺炎链球菌以外的病原体引起。特异性为96%，阳性预测值在88.8%至96.5%之间，阳性似然比在14.6至19.9之间。检测结果使临床医生对41例患者缩小了抗生素使用范围。所有这些患者的肺炎均治愈。潜在地，对于仅通过该检测确诊的75例患者也可能实现这种优化。
当肺炎球菌尿抗原检测结果为阳性时，它是治疗CAP住院成年患者的有用工具，因为它可能使临床医生优化抗菌治疗并取得良好的临床效果。
