title: Invasive Disease vs Urinary Antigen-Confirmed Pneumococcal Community-Acquired Pneumonia.
abstract: The burden of pneumococcal disease is measured only through patients with invasive pneumococcal disease. The urinary antigen test (UAT) for pneumococcus has exhibited high sensitivity and specificity. We aimed to compare the pneumococcal pneumonias diagnosed as invasive disease with pneumococcal pneumonias defined by UAT results.
  
  
  
  A prospective observational study of consecutive nonimmunosuppressed patients with community-acquired pneumonia was performed from January 2000 to December 2014. Patients were stratified into two groups: invasive pneumococcal pneumonia (IPP) defined as a positive blood culture or pleural fluid culture result and noninvasive pneumococcal pneumonia (NIPP) defined as a positive UAT result with negative blood or pleural fluid culture result.
  
  
  
  We analyzed 779 patients (15%) of 5,132, where 361 (46%) had IPP and 418 (54%) had NIPP. Compared with the patients with IPP, those with NIPP presented more frequent chronic pulmonary disease and received previous antibiotics more frequently. Patients with IPP presented more severe community-acquired pneumonia, higher levels of inflammatory markers, and worse oxygenation at admission; more pulmonary complications; greater extrapulmonary complications; longer time to clinical stability; and longer length of hospital stay compared with the NIPP group. Age, chronic liver disease, mechanical ventilation, and acute renal failure were independent risk factors for 30-day crude mortality. Neither IPP nor NIPP was an independent risk factor for 30-day mortality.
  
  
  
  A high percentage of confirmed pneumococcal pneumonia is diagnosed by UAT. Despite differences in clinical characteristics and outcomes, IPP is not an independent risk factor for 30-day mortality compared with NIPP, reinforcing the importance of NIPP for pneumococcal pneumonia.
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Sección Neumología, Hospital Nacional Alejandro Posadas, El Palomar, Argentina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ceccato
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. Electronic address: atorres@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Catia
authors.initials: C
authors.lastname: Cilloniz
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Rosanel
authors.initials: R
authors.lastname: Amaro
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrus
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Prina
authors.affiliation: Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Garcia-Vidal
authors.affiliation: Facultad de Enfermería, Universidad de Valladolid, Valladolid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Muñoz-Conejero
authors.affiliation: Medical Department, Pfizer S.L.U., Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mendez
authors.affiliation: Medical Department, Pfizer S.L.U., Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cifuentes
authors.affiliation: Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Puig de la Bella Casa
authors.affiliation: Department of Pneumology, IIS/Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian/Weill Cornell Medical Center, New York, NY.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Niederman
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000652:urine; D016470:Bacteremia / Q000097:blood / Q000453:epidemiology*; D000071997:Blood Culture; D002908:Chronic Disease; D017714:Community-Acquired Infections / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011008:Pneumococcal Infections / Q000097:blood / Q000453:epidemiology / Q000401:mortality / Q000652:urine; D011018:Pneumonia, Pneumococcal / Q000097:blood / Q000453:epidemiology* / Q000401:mortality / Q000652:urine; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000276:immunology; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial
keywords: Streptococcus pneumoniae; burden of pneumococcal disease; community-acquired pneumonia; diagnosis; urinary antigen test