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The University of Louisville Journal of Respiratory Infections

Abstract

Background: The etiologic diagnosis of community acquired pneumonia (CAP) and community-acquired meningitis (CAM) are still far from optimal accuracy and turnaround time. The most common bacterial pathogen identified in both CAP and CAM is Streptococcus pneumoniae.

Methods: We reviewed the literature on S. pneumoniae antigen to highlight opportunities to optimize its use as a point of care diagnostic test to maximize quality of patient care, antimicrobial stewardship outcomes and cost saving. A PubMed search was performed using key words “S. pneumoniae antigen; rapid diagnostic tests for S. pneumoniae”. We selected articles in English and sorted into randomized controlled trials (RCT), case control, and retrospectives studies.

Results: The BinaxNOW S. pneumoniae antigen rapid immunochromatographic test (ICT) to detect C-polysaccharide cell wall antigen was approved by the Food and Drug Administration (FDA) in 2003. This test has a turn around time of 15 minutes, a sensitivity of 52-82% and specificity of 89.7-99.7% in urine and 95.4-100% and 99.3-100% respectively in cerebrospinal fluid (CSF) specimens. BinaxNOW detected the antigen in 100% of blood culture bottles that grew S. pneumoniae. S. pneumoniae urinary antigen has a sensitivity of 77-92% in bacteremic pneumococcal pneumonia and 52-78% non-bacteremic pneumococcal pneumonia. This test was reported to be inexpensive and useful in streamlining antibiotic treatment. In a physician survey, this test led to a narrowed antibiotic regimen, shorter duration of antibiotics treatment and fewer diagnostic tests.

Conclusion: S. pneumoniae ICT urinary antigen has an optimal yield to support the etiologic diagnosis of CAP and up to 15-minute turnaround time that could facilitate he selection of a one-antibiotic regimen upon the hospital admission of a patient with CAP. Similarly, S. pneumoniae CSF antigen test should be considered a standard test for the evaluation of patients with meningitis.

DOI

10.18297/jri/vol1/iss4/11

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