Streptococcus pneumoniae Antigen, Missing Opportunities of a Promising Point of Care Diagnostic Test

Authors

Magdelina Słomka, St. Vincent Charity Medical Center, Cleveland, OHFollow
Ruby Gupta, Keystone Health Center, Chambersburg, PAFollow
Baltej Singh, Jersey City Medical Center, Jersey City, NJFollow
Venkatesh Gondhi, Providence Health System, Center for Infectious Diseases, Washington, DCFollow
Siddartha Bhandary, Providence Health System, Center for Infectious Diseases, Washington, DCFollow
Ekezie Francis, Keystone Health Center, Chambersburg, PAFollow
Jose Bordon, Providence Health System, Center for Infectious Diseases, Washington, DCFollow

Funder

The author(s) received no specific funding for this work.

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

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Słomka, Magdelina; Gupta, Ruby; Singh, Baltej; Gondhi, Venkatesh; Bhandary, Siddartha; Francis, Ekezie; and Bordon, Jose (2017) "Streptococcus pneumoniae Antigen, Missing Opportunities of a Promising Point of Care Diagnostic Test," The University of Louisville Journal of Respiratory Infections: Vol. 1 : Iss. 4 , Article 11.
DOI: https://doi.org/10.18297/jri/vol1/iss4/11
Available at: https://ir.library.louisville.edu/jri/vol1/iss4/11