title: Diagnostic accuracy of a serotype-specific antigen test in community-acquired pneumonia.
abstract: Our aim was to evaluate the diagnostic accuracy and clinical utility of a serotype-specific urinary antigen detection multiplex assay for identification of 13 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F) in urine of patients with community-acquired pneumonia. Adult patients with clinical suspicion of community-acquired pneumonia were included. In addition to standard diagnostic procedures, a urine sample was collected to perform the urinary antigen detection test. Demographic, clinical, radiological and microbiological data were collected. Among 1095 community-acquired pneumonia patients Streptococcus pneumoniae was identified as causative pathogen in 257 (23%), when using conventional diagnostic methods and in 357 (33%) when urinary antigen detection was added. Of the 49 bacteraemic episodes caused by one of the 13 serotypes covered by the urinary antigen detection, 48 were detected by the urinary antigen detection, indicating a sensitivity of 98%. Of the 77 community-acquired pneumonia episodes with a "non-urinary antigen detection" causative pathogen, none had a positive urinary antigen detection result, indicating a specificity of 100%. Addition of the urinary antigen detection test to conventional diagnostic methods increased the prevalence of S. pneumoniae community-acquired pneumonia by 39%. Using bacteraemic episodes as reference sensitivity and specificity of the urinary antigen detection was 98% and 100%, respectively.
authors: University Medical Center Utrecht, Utrecht.
authors: Susanne M
authors: SM
authors: Huijts
authors: Michael W
authors: MW
authors: Pride
authors: Josephine M I
authors: JM
authors: Vos
authors: Kathrin U
authors: KU
authors: Jansen
authors: Chris
authors: C
authors: Webber
authors: William
authors: W
authors: Gruber
authors: Wim G
authors: WG
authors: Boersma
authors: Dominic
authors: D
authors: Snijders
authors: Jan A J W
authors: JA
authors: Kluytmans
authors: Ivo
authors: I
authors: van der Lee
authors: Bart A F
authors: BA
authors: Kuipers
authors: Arie
authors: A
authors: van der Ende
authors: Marc J M
authors: MJ
authors: Bonten
mesh_terms: D000368:Aged; D000942:Antigens, Bacterial / Q000652:urine*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000276:immunology / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis* / Q000276:immunology / Q000652:urine*; D011134:Polysaccharides / Q000032:analysis; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000942:Antigens, Bacterial; D011134:Polysaccharides