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Invasive Disease vs Urinary Antigen-Confirmed Pneumococcal Community-Acquired Pneumonia

Adrian Ceccato1, Antoni Torres2, Catia Cilloniz2

  • 1Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Sección Neumología, Hospital Nacional Alejandro Posadas, El Palomar, Argentina.

Chest
|January 18, 2017
PubMed
Abstract

Insights

The urinary antigen test (UAT) identifies more pneumococcal pneumonia cases than traditional methods. Invasive and non-invasive pneumococcal pneumonia show different clinical features but similar mortality risks.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Clinical Microbiology

Background:

  • Pneumococcal disease burden is often underestimated by focusing solely on invasive cases.
  • The urinary antigen test (UAT) for Streptococcus pneumoniae demonstrates high sensitivity and specificity.
  • Current diagnostic approaches may not fully capture the prevalence of pneumococcal pneumonia.

Purpose of the Study:

  • To compare pneumococcal pneumonias diagnosed as invasive disease versus those identified by UAT.
  • To evaluate the clinical characteristics and outcomes of invasive versus non-invasive pneumococcal pneumonia.
  • To assess the diagnostic utility of UAT in community-acquired pneumonia.

Main Methods:

  • A prospective observational study included 5,132 non-immunosuppressed patients with community-acquired pneumonia (2000-2014).
  • Patients were classified into invasive pneumococcal pneumonia (IPP) (positive blood/pleural fluid culture) and non-invasive pneumococcal pneumonia (NIPP) (positive UAT, negative cultures).
  • Clinical data, complications, and 30-day mortality were analyzed.

Main Results:

  • Of 5,132 patients, 779 (15%) had pneumococcal pneumonia: 361 IPP (46%) and 418 NIPP (54%).
  • NIPP patients more frequently had chronic lung disease and prior antibiotic use.
  • IPP was associated with more severe pneumonia, higher inflammatory markers, worse oxygenation, more complications, and longer hospital stays.
  • Independent risk factors for 30-day mortality included age, chronic liver disease, mechanical ventilation, and acute renal failure.

Conclusions:

  • UAT identifies a significant proportion of pneumococcal pneumonia cases.
  • Despite clinical differences, IPP is not an independent predictor of 30-day mortality compared to NIPP.
  • NIPP plays a crucial role in the overall burden and management of pneumococcal pneumonia.
Keywords:
Streptococcus pneumoniaeburden of pneumococcal diseasecommunity-acquired pneumoniadiagnosisurinary antigen test

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