Pneumococcal Community-Acquired Pneumonia Detected by Serotype-Specific Urinary Antigen Detection Assays

Richard G. Wunderink, Wesley H. Self, Evan J. Anderson, Robert Balk, Sherene Fakhran, Daniel Mark Courtney, Chao Qi, Derek J. Williams, Yuwei Zhu, Cynthia G. Whitney, Matthew R. Moore, Anna Bramley, Seema Jain, Kathryn M. Edwards, Carlos G. Grijalva

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Background Streptococcus pneumoniae is considered the leading bacterial cause of pneumonia in adults. Yet, it was not commonly detected by traditional culture-based and conventional urinary testing in a recent multicenter etiology study of adults hospitalized with community-acquired pneumonia (CAP). We used novel serotype-specific urinary antigen detection (SSUAD) assays to determine whether pneumococcal cases were missed by traditional testing. Methods We studied adult patients hospitalized with CAP at 5 hospitals in Chicago and Nashville (2010-2012) and enrolled in the Etiology of Pneumonia in the Community (EPIC) study. Traditional diagnostic testing included blood and sputum cultures and conventional urine antigen detection (ie, BinaxNOW). We applied SSUAD assays that target serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13) to stored residual urine specimens. Results Among 1736 patients with SSUAD and ≥1 traditional pneumococcal test performed, we identified 169 (9.7%) cases of pneumococcal CAP. Traditional tests identified 93 (5.4%) and SSUAD identified 76 (4.4%) additional cases. Among 14 PCV13-serotype cases identified by culture, SSUAD correctly identified the same serotype in all of them. Cases identified by SSUAD vs traditional tests were similar in most demographic and clinical characteristics, although disease severity and procalcitonin concentration were highest among those with positive blood cultures. The proportion of PCV13 serotype cases identified was not significantly different between the first and second July-June study periods (6.4% vs 4.0%). Conclusions Although restricted to the detection of only 13 serotypes, SSUAD testing substantially increased the detection of pneumococcal pneumonia among adults hospitalized with CAP.

Original languageEnglish (US)
Pages (from-to)1504-1510
Number of pages7
JournalClinical Infectious Diseases
Volume66
Issue number10
DOIs
Publication statusPublished - May 2 2018
Externally publishedYes

    Fingerprint

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this