The University of Louisville Journal of Respiratory Infections


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.


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



Creative Commons License

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



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.