We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Pneumococcal and Legionella Urinary Antigen Tests in Community-acquired Pneumonia: Prospective Evaluation of Indications for Testing.
- Authors
Bellew, Shawna; Grijalva, Carlos G; Williams, Derek J; Anderson, Evan J; Wunderink, Richard G; Zhu, Yuwei; Waterer, Grant W; Bramley, Anna M; Jain, Seema; Edwards, Kathryn M; Self, Wesley H
- 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.
- Subjects
STREPTOCOCCAL disease diagnosis; LEGIONNAIRES' disease diagnosis; AMERICAN Medical Association; AMERICAN Thoracic Society; BACTERIAL antigens; CONFIDENCE intervals; DIARRHEA; FEVER; HOSPITAL care; HYPONATREMIA; LEGIONELLA; LONGITUDINAL method; MEDICAL cooperation; PUBLIC health surveillance; RESEARCH; STREPTOCOCCUS; LOGISTIC regression analysis; COMMUNITY-acquired pneumonia
- Publication
Clinical Infectious Diseases, 2019, Vol 68, Issue 12, p2026
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy826