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( Srinivasa Raghavan Madhavan ),( David Drone ),( Melissa Rohrich ),( Kimberly Hammer ),( Tze Shien Lo ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Streptococcus pneumoniae(SP) is an important causative organism of Lower respiratory tract infection (LRTI), including pneumonia bronchitis and exacerbation of Chronic Obstructive Pulmonary Disease (COPD). LRTI secondary to SP is under-diagnosed due to limitations in current diagnostic techniques, using blood or sputum culture. Pneumococcal Urine Antigen (PUA) test, is an in vitro rapid immunochromatographic assay for the detection of PUA in the urine (BinaxNOW; Alere,USA) of patients with pneumonia. The package insert of BinaxNOW states the test has a sensitivity of 86% and specificity of 94% based on patients with positive blood culture for SP. We sought to test the efficacy of this test in diagnosing LRTI due to SP in the Veterans Affairs Medical Center. Methods: Newly hospitalized patients with at least two of the following: fever, sputum production, cough, new and worsening shortness of breath and leukocytosis were eligible to participate. Patients were diagnosed with pneumonia based on new infiltrate or consolidation. Results: A total of 166 patients, with LRTI were prospectively enrolled over 2 years. The mean age was 68(±12) years. Pneumonia, COPD and bronchitis were diagnosed in 60,67 and 39 patients respectively. Overall, 6 patients tested positive for PUA(3.6%), 3 had pneumonia and 3 had COPD. SP grew in the blood of 7 patients, out of whom, 6 patients had pneumonia. Only 2 of the 7 (28%) blood culture positive patients tested positive with the PUA test. Conclusions: Contrary to the manufacturer`s assertion of high sensitivity of PUA test, our study shows a very low rate of positive PUA among patients admitted with LRTI, including patients having SP bacteremia. Our study questions the high sensitivity of PUA test claimed by the manufacturer. A larger multi-center prospective study is needed to verify our findings.
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