Usefulness of pneumococcal antigen urinary testing in the intensive care unit?
OBJECTIVE
The use of pneumococcal antigen urinary tests is substantially increasing and is associated with a significant cost. The relevant use of this test in the intensive care unit (ICU) should be better defined. Our aim was to define the role of this test in relation to other microbiological tests. We described a series of patients admitted to the ICU for an invasive pneumococcal disease (IPD).


METHODS
We conducted a retrospective and descriptive study of the microbiological tests used to diagnose IPD in patients admitted to the ICU of the University Hospital in Bordeaux. Our aim was to measure the sensitivity of these bacteriological tests and of the BinaxNOWS. pneumoniae test.


RESULTS
Between 2009 and 2013, 148 patients were admitted for an IPD. A lower respiratory tract infection was diagnosed in 96.6% of them (143 patients). The overall ICU case fatality rate was 17.6%. The sensitivity of the pneumococcal antigen urinary test, sputum bacteriological examination, and blood cultures was respectively 83%, 37.6%, and 29.7%. S. pneumoniae was isolated from at least one bacteriological sample in 48.6% of patients, but in 51.4%, the diagnosis was only based on the results of the pneumococcal antigen urinary test.


CONCLUSIONS
We suggest performing a pneumococcal antigen urinary test when an IPD is suspected, only if the bacteriological tests are still negative after 48hours. This strategy would result in a substantial cost saving. Patients would not face any additional risks as the result of the pneumococcal antigen urinary test does not have any impact on the initially prescribed antibiotic therapy.
Service de réanimation médicale, groupe Saint-André, CHU de Bordeaux, 33000 Bordeaux, France.
F
F
Camou
Service de réanimation médicale, groupe Saint-André, CHU de Bordeaux, 33000 Bordeaux, France. Electronic address: nahema.issa@chu-bordeaux.fr.
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N
Issa
Laboratoire de bactériologie, groupe Pellegrin-Tripode, CHU de Bordeaux, 33000 Bordeaux, France.
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É
Bessede
Service de réanimation médicale, groupe Saint-André, CHU de Bordeaux, 33000 Bordeaux, France.
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G
Mourissoux
Service de réanimation médicale, groupe Saint-André, CHU de Bordeaux, 33000 Bordeaux, France.
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O
Guisset
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000652:urine*; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control / Q000652:urine*; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000097:blood / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000652:urine*; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial
Antigènurie pneumococcique; Infection invasive à pneumocoque; Intensive care unit; Pneumococcal antigen urinary test; Pneumococcal invasive disease; Réanimation; Streptococcus pneumoniae