Is the pneumococcal urinary antigen test still fit for purpose? a decade of experience

To evaluate the utilization and clinical impact of pneumococcal urinary antigen (PUA) testing over a ten-year period in a tertiary hospital and assess implications for diagnostic stewardship.

A retrospective review of all PUA tests performed between 2014 and 2023 was conducted. Laboratory data was linked with hospital discharge coding to determine alignment with community-acquired pneumonia (CAP) diagnoses. For positive test results, clinical records were reviewed to examine antimicrobial decision-making and pneumococcal vaccination recommendations.

Across the decade, 7,178 PUA tests were performed, with a positivity rate of 7.6%. Overall, 42% of tests were ordered in patients without a CAP diagnosis, generating approximately €17,000 annually in avoidable test costs and 75 hours of additional staff workload. Among positive cases, 87% resulted in no alteration of antimicrobial therapy. Pneumococcal vaccination recommendations were documented in only 13.5% of test-positive cases.

PUA testing was frequently overused and had limited influence on clinical management or preventative care. These findings support restricting its use in line with updated guideline recommendations and reinforce the need for strengthened diagnostic stewardship.