The problem, the consequences, and rapid testing solutions
Community-Acquired Pneumonia (CAP) is a common disease that is associated with considerable mortality and morbidity, and accounts for high antibiotic consumption.1
Among adults in industrialized countries, pneumococcal pneumonia still accounts for at least 30% of all cases of community-acquired pneumonia admitted to the hospital, with a case fatality rate of 11% to 44%.2 Although numerous pathogens can cause CAP, Streptococcus pneumoniae remains the leading bacterial cause worldwide and the leading cause of mortality. It is also the most likely pathogen in patients with CAP admitted to the ICU.3
Current evidence supports that antibiotics should be administered 4-6 hours after the patient arrives at the hospital. Because results of definitive diagnostic tests for pneumonia are not available for several days, broad-spectrum antibiotics are prescribed.
The yield of traditional microbiological investigations for diagnosis of CAP is limited for several reasons: routine difficulties in obtaining good-quality sputum and the uncertainty of the value of its culture results, low sensitivity of blood cultures, and administration of antibiotics before samples collection.4
The delay of a definitive and focused diagnosis may cause patients to be at risk for adverse reactions due to the empirical use of broad-spectrum antibiotics. Some broad-spectrum antibiotics i.e., cephalosporins or fluoroquinolones used to treat CAP have been strongly associated with Clostridium difficile- associated diarrhea (CDAD) and methicillin-resistant Staphylococcus aureus (MRSA).5
Your elderly patient is admitted to the emergency department with moderate to severe community acquired pneumonia (CAP). Which diagnostic pathway do you choose for your patient?
Early and rapid diagnosis of CAP would allow more directed therapy and confidence in appropriate treatment for a majority of patients.6 Using an appropriate pathogen-focused antibiotic or narrowing empirical therapy may decrease cost, drug adverse events, and the threat of antibiotic resistance.7
A rapid and simple urine antigen test (UAT), BinaxNOW® Streptococcus pneumoniae based on immunochromatographic technique, is widely available to detect the C-polysaccharide antigen of S. pneumoniae in just 15 minutes. The high specificity, positive predictive value, and positive likelihood ratio makes BinaxNOW® S. pneumoniae a useful tool in the treatment of adult patients with CAP. The BinaxNOW® S. pneumoniae Urinary Antigen Card can be read visually or with the Alere™ Reader*, soon to be DIGIVAL™.
In one study, the BinaxNOW® UAT was the only diagnostic test positive for S. pneumoniae for 32 patients. Had this test not been available, these patients would have received diagnoses of pneumonia due to atypical pathogens or unknown etiology, and according to current guidelines, would have received broad-spectrum antibiotic therapy. However, these patients fared just as well receiving a penicillin.8
The BinaxNOW® S. pneumoniae is advocated by numerous worldwide CAP guidelines including IDSA/ATS, BTS, SPILF and SEPAR. The IDSA/ATS CAP guidelines conclude that only 50% of BinaxNOW® S. pneumoniae UAT positive patients can be diagnosed by conventional methods.9
*Only available in select markets.
- Oosterheert, J. et al. (2005) Predicted effects on antibiotic use following the introduction of British or North American guidelines for community-acquired pneumonia in The Netherlands. Clin Microbiol Infect. 11(12):992-8.
- World Health Organization (WHO) (2009) Acute Respiratory Infections: Streptococcus pneumoniae. [Online] Available from: http://www.who.int/vaccine_research/diseases/ari/en/index3.html Accessed: 08 Mar 13
- Chiou, C. and Lu, V.L. (2006) Severe pneumococcal pneumonia: new strategies for management. Current Opinion in Critical Care, 12:000–000.
- Sordé, R. et al. (2010) Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy. Arch Intern Med. 27.
- Dryden, M., Hand, K. and Davey, P. (2009) Antibiotics for Community Acquired Pneumonia. Journal of Antimicrobial Chemotherapy, 64, 1123–1125.
- Weatherall, C., Paoloni, R. and Gottlieb, T. (2008) Point-of-care urinary pneumococcal antigen test in the emergency department for community acquired pneumonia. Emerg Med J, 25(3):144-8.
- File Jr, T.M. and Kozlov, R.S. (2006) Rapid detection of Streptococcus pneumoniae in community-acquired Pneumonia. Clin Microbiol Infect, 12 (suppl 9): 27–33.
- Matta, M. et al. (2009) Do Clinicians Consider the Results of Binax NOW Streptococcus pneumoniae Urinary Antigen to Adapt Antibiotic Regimen in Pneumonia Patients? Clinical Microbiology and Infection. Accepted Article 2009 Oct.
- Mandell, L.A. et al. (2007) Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases, 44:S27-72.
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