Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy

2016 ◽  
Vol 46 (7) ◽  
pp. 365-371 ◽  
Author(s):  
A. Mothes ◽  
S. Léotard ◽  
I. Nicolle ◽  
A. Smets ◽  
D. Chirio ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Community Acquired Pneumonia ◽  
Urinary Antigen ◽  
Factors Associated ◽  
Antigen Tests

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

scholarly journals Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1950
Author(s):  
Giulia Scioscia ◽  
Rosanel Amaro ◽  
Victoria Alcaraz-Serrano ◽  
Albert Gabarrús ◽  
Patricia Oscanoa ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Prospective Observational Study ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Factors ◽  
Treatment Results ◽  
Factors Associated ◽  
Long Term Oxygen Therapy

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

scholarly journals Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

2018 ◽  
Vol 44 (4) ◽  
pp. 261-266 ◽  
Author(s):  
Laura Fuchs Bahlis ◽  
Luciano Passamani Diogo ◽  
Ricardo de Souza Kuchenbecker ◽  
Sandra Costa Fuchs
Keyword(s):  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Public Hospital ◽  
Community Acquired Pneumonia ◽  
Factors Associated ◽  
Icu Admission ◽  
Patient Profile

ABSTRACT Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.

scholarly journals Prevalence and Utility of Positive Pneumococcal Urinary Antigen Tests in Australian Patients with Community-Acquired Pneumonia

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Lauren K. Troy ◽  
Keith K. H. Wong ◽  
David J. Barnes
Keyword(s):  
Clinical Utility ◽  
Length Of Hospital Stay ◽  
Community Acquired Pneumonia ◽  
Urinary Antigen ◽  
Single Centre ◽  
Cross Sectional ◽  
Single Centre Study ◽  
Antigen Tests ◽  
Positive Results ◽  
Care Support

Background and Objectives. The pneumococcal urinary antigen test (UAT) has superior sensitivity to other investigations in determining the aetiology of community-acquired pneumonia (CAP), but data specific to Australian populations is limited. This study aimed to establish the prevalence and clinical utility of positive UAT in patients admitted to hospital with CAP, as well as associations with positive testing. Methods. A prospective, cross-sectional, single-centre study was performed. Urine antigen tests were performed on all adult patients admitted to hospital with the diagnosis of CAP. Sputum and blood culture results, CURB-65 score of severity, current and prior antibiotics, comorbidities, mortality, and length of hospital stay were recorded. Results. There was a positive test prevalence of 13/170 [7.6% (95% confidence intervals 4.3–13%)]. The overall prevalence of pneumococcal pneumonia was 19/170 (11%), including 8 patients confirmed on positive UAT alone. Patients with a positive UAT result had a higher mean CURB-65 score compared with those with a negative result (P=0.01), and a greater likelihood of requiring intensive care support (P=0.006). Conclusions. The prevalence of positive UAT was low. Positive results were more often recorded in those with greater severity pneumonia. The clinical utility of the test in this cohort of patients was low.

scholarly journals An Outbreak of Pneumococcal Pneumonia Among Residents of a Retirement Home in France During October 2003

2006 ◽  
Vol 27 (11) ◽  
pp. 1252-1254 ◽  
Author(s):  
Y. Hansmann ◽  
A. Doyle ◽  
V. Remy ◽  
B. Jaulhac ◽  
D. Christmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Streptococcus Pneumoniae ◽  
Antibiotic Therapy ◽  
Pneumococcal Pneumonia ◽  
Control Measures ◽  
Retirement Home ◽  
Urinary Antigen ◽  
Antigen Tests ◽  
Positive Results

We describe an outbreak of pneumonia due to Streptococcus pneumoniae in a French retirement home. Eleven residents developed pneumonia. Eight patients had positive results of urinary antigen tests. There were no further cases after the implementation of control measures, which involved isolation of and receipt of antibiotic therapy by symptomatic residents. No risk factors for transmission of S. pneumoniae were identified in this population.

scholarly journals Comparison of Two Urinary Antigen Tests for Establishment of Pneumococcal Etiology of Adult Community-Acquired Pneumonia

2004 ◽  
Vol 42 (8) ◽  
pp. 3620-3625 ◽  
Author(s):  
K. Stralin ◽  
M. S. Kaltoft ◽  
H. B. Konradsen ◽  
P. Olcen ◽  
H. Holmberg
Keyword(s):  
Community Acquired Pneumonia ◽  
Urinary Antigen ◽  
Antigen Tests

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.

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