medigraphic.com
ISSN 0185-6014 (Print)
Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2015, Number 4

<< Back Next >>

Rev Mex Patol Clin Med Lab 2015; 62 (4)

Utility of the «pneumococcal urinary antigen» detection at a university hospital

Caiata L, Barone N, Palacio R, Seija V

Language: Spanish
References: 21
Page: 256-261
PDF size: 224.49 Kb.


ABSTRACT

Introduction: Acute community-acquired pneumonia (CAP) is one of the major causes of morbidity and mortality, BinaxNOW® Streptococcus pneumoniae urinary antigen is used for etiologic diagnosis. Objective: To determine whether the application of this test is adjusted to the indications for its realization, alternative diagnoses to its request and investigate the impact of a positive result in the prescription of antibiotics in adult patients with CAP. Material and methods: Descriptive, transversal study. All patients to whom this test was requested were included. It was considered that the indication of the test was adequate when the patient had moderate-severe CAP. Results: 225 determinations were requested, 14 were positive (6.2%). 71 patients had no diagnosis of CAP: 154 medical records were reviewed. One hundred and sixteen patients had no adequate indication. The emergency department was the service that requested greater number of determinations (n = 179, 79.6%). Only in a case of positive test, treatment was adjusted. Conclusions: More than 50% of the tests were not correctly indicated. We need to work on a more appropriate use of this test, reserving it for patients with severe CAP where the test has a higher sensitivity.


REFERENCES

  1. Mandell LA, Wunderink RG, Anzueto A, Barlett JG, Campbell GD, Dean NC et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 (Suppl 2): S527-572.

  2. Falguera M, Gudiol F, Sabriá M, Álvarez-Lerma F y Cordero E. Infecciones en el tracto respiratorio inferior-Neumonía adquirida en la comunidad. Protocolos Clínicos SEIMC. [Citado 09 de abril de 2015]. Disponible: http://www.seimc.org/contenidos/documentoscientificos/procedimientosclinicos/seimc-procedimientoclinicoi.pdf

  3. Irizar MI, Arrondo MA, Insausti MJ, Mujica J, Etxabarri P, Ganzarain R. Epidemiología de la neumonía adquirida en la comunidad. Aten Primaria. 2013; 45: 503-513.

  4. Estadísticas de mortalidad. Ministerio de Salud Pública de Uruguay. Disponible en: http://www.msp.gub.uy/publicaci%C3%B3n/estad%C3%ADsticas-de-mortalidad

  5. Centers for Disease Control and Prevention (CDC). Effects of the new penicillin susceptibility breakpoints for Streptococcus pneumoniae-United States 2006-2007. MMWR Morb Mortal Wkly Rep. 2008; 57: 1353-1355.

  6. Weinstein MP, Klugman KP, Jones RN. Rationale for revised penicillin susceptibility breakpoints for Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance. Clin Infect Dis. 2009; 48: 1596-1600.

  7. Troy KL, Wong KK, Barnes DJ. Prevalence and utility of positive pneumococcal urinary antigen tests in Australian patients with community-acquired pneumonia. ISRN Infectious Diseases. 2013. Article ID518205, 5.

  8. Sorlózano A, Cedeño S, Gutiérrez-Fernández J, Polo P, Navarro JM. Relevancia de la detección del antígeno de Streptococcus pneumoniae en orina en el diagnóstico de las infecciones de las vías respiratorias bajas. Rev Esp Quimioter. 2013; 26 (1): 39-42.

  9. Bantar C, Curcio D, Jasovich A, Bagnulo H, Arango A, Bavestrello L, et al. Neumonía aguda adquirida en la comunidad en adultos: Actualización de los lineamientos para el tratamiento antimicrobiano inicial basado en la evidencia local del Grupo de Trabajo de Sudamérica (ConsenSurII). Rev Chil. Infect 2010; 27 (Supl 1): 9-38.

  10. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. American Thoracic Society Documents. AM J Respir Crit Care Med 2005; 171: 388-416.

  11. Seija V, Palacio R, Legnani M, Bazet C. Valor diagnóstico del Test Binax NOW para detectar la etiología neumocócica en la Neumonía Aguda Comunitaria del Adulto. Arch Med Interna 2007; XXIX (1): 21-26

  12. Palacio R, Ruchasky D, Camou T, Alonso R, Goni N, Russi J, Bazet C. Neumonía Aguda comunitaria en el adulto hospitalizado : aspectos etiológicos, clínicos – terapéuticos y evolutivos. Arch Med Interna 2007; XXIX (1): 14-20

  13. García Gabarrot G, López Vega M, Pérez Giffoni G, Hernández S, Cardinal P, et al. Effect of Pneumococcal Conjugate Vaccination in Uruguay, a Middle-Income Country. PLoS ONE 2014; 9: e112337

  14. Piso RJ, Iven-Koller D, Koller MT, Bassetti S. The routine use of the urinary pneumococcal antigen test in hospitalized patients with community acquired pneumonia has limited impact for adjustment of antibiotic treatment. Swiss Med Wkly. 2012; 142: w13679.

  15. Engel MF, Van Velzen M, Hoepelman AIM, Thijsen S, Oosterheert JJ. Positive urinary antigen tests for Streptococcus pneumoniae in community-acquired pneumonia: a 7-year retrospective evaluation of health care cost and treatment consequences. Eur J Clin Microbiol Infect Dis. 2013; 32: 485-492.

  16. Nishimura K, Nishimura T, Oga T. Streptococcus pneumoniae urinary antigen test and acute exacerbations of chronic obstructive pulmonary disease. COPD. 2012; 9: 344-351.

  17. CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI document M100-S23. Wayne; PA: Clinical and Laboratory Standards Institute; 2013.

  18. Domínguez J, Gali N, Blanco S et al. Detection of Streptococcus pneumoniae antigen by a rapid immunocromatographic assay in urine samples. Chest. 2001; 119: 243-249.

  19. Gutierrez F, Maisá M, Rodríguez JC et al. Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin Infect Dis. 2003; 36: 286-292.

  20. Murdoch DR, Laing RT, Mills Gd et al. Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol. 2001; 39: 3495-3498.

  21. Zalacain R, Capelastegui A, Ruiz LA, Bilbao A, Gómez A, Uranga A et al. Streptococcus pneumoniae antigen in urine: diagnostic usefulness and impact on outcome of bactaraemic pneumococcal pneumonia in large series of adult patients. Respirology. 2014; 19: 936-943.




2020     |     www.medigraphic.com