CAP規則測驗urinary pneumococcal Ag可以改變用藥
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Pneumococcal Urinary Antigen Screening in Hospitalized Patients with Community-Acquired Pneumonia
Such screening could optimize antibiotic therapy.
Although community-acquired pneumonia (CAP) is common, our ability to determine its etiology is limited. This determination is extremely important in ensuring appropriate therapy. A pneumococcal urinary antigen (PUA) test has been available for some time and has been used in CAP, but its role is not clearly defined. To explore this issue, researchers conducted a prospective evaluation of such screening. The study was performed at a single medical center in Spain and included all consecutive adults (age, ≥16 years) who were hospitalized for CAP between February 2007 and January 2008.
Definite determination of CAP etiology was defined as isolation of a pathogen from a normally sterile sample (blood or pleural fluid); a positive result on a urinary antigen test for detection of Legionella pneumophila; a fourfold increase in the antibody titer for Mycoplasma pneumoniae, Chlamydophila pneumoniae, Coxiella burnetii, or L. pneumophila between acute and convalescent serum samples; or a positive polymerase chain reaction result for Streptococcus pneumoniae in pleural fluid. Probable determination was defined as isolation of one predominant organism in a good-quality sputum culture with a concordant morphotype on Gram stain.
A total of 464 patients with 474 episodes of CAP were included. PUA screening was performed in 78 episodes of definite or probable pneumococcal pneumonia, and the results were positive in 55 (70.5%). S. pneumoniae was detected by this assay (and only by this assay) in 75 additional CAP episodes.
Positive PUA results prompted an antibiotic revision in 41 CAP episodes (8.6%); treatment was not modified despite positive PUA results in 89 (18.8%).
Comment: PUA screening can affect both diagnosis and management of CAP. The tool is problematic for some clinicians because it is a "send out" test with delay in obtaining results. Also, as is evidenced in the current investigation, clinicians' antimicrobial-prescribing habits are difficult to change, even when test results indicate the need for modification.
— Larry M. Baddour, MD
Published in Journal Watch Infectious Diseases October 6, 2010
Citation(s):
Sordé R et al. Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy. Arch Intern Med 2010 Sep 27; [e-pub ahead of print]. (http://dx.doi.org/10.1001/archinternmed.2010.347)
https://docs.google.com/fileview?id=0B278nGJMQBk7ZDBkNTEyYzgtOWJjNi00YjJiLWFmZjgtMmQxNGIzNTM4ZmE0&hl=zh_TW
Pneumococcal Urinary Antigen Screening in Hospitalized Patients with Community-Acquired Pneumonia
Such screening could optimize antibiotic therapy.
Although community-acquired pneumonia (CAP) is common, our ability to determine its etiology is limited. This determination is extremely important in ensuring appropriate therapy. A pneumococcal urinary antigen (PUA) test has been available for some time and has been used in CAP, but its role is not clearly defined. To explore this issue, researchers conducted a prospective evaluation of such screening. The study was performed at a single medical center in Spain and included all consecutive adults (age, ≥16 years) who were hospitalized for CAP between February 2007 and January 2008.
Definite determination of CAP etiology was defined as isolation of a pathogen from a normally sterile sample (blood or pleural fluid); a positive result on a urinary antigen test for detection of Legionella pneumophila; a fourfold increase in the antibody titer for Mycoplasma pneumoniae, Chlamydophila pneumoniae, Coxiella burnetii, or L. pneumophila between acute and convalescent serum samples; or a positive polymerase chain reaction result for Streptococcus pneumoniae in pleural fluid. Probable determination was defined as isolation of one predominant organism in a good-quality sputum culture with a concordant morphotype on Gram stain.
A total of 464 patients with 474 episodes of CAP were included. PUA screening was performed in 78 episodes of definite or probable pneumococcal pneumonia, and the results were positive in 55 (70.5%). S. pneumoniae was detected by this assay (and only by this assay) in 75 additional CAP episodes.
Positive PUA results prompted an antibiotic revision in 41 CAP episodes (8.6%); treatment was not modified despite positive PUA results in 89 (18.8%).
Comment: PUA screening can affect both diagnosis and management of CAP. The tool is problematic for some clinicians because it is a "send out" test with delay in obtaining results. Also, as is evidenced in the current investigation, clinicians' antimicrobial-prescribing habits are difficult to change, even when test results indicate the need for modification.
— Larry M. Baddour, MD
Published in Journal Watch Infectious Diseases October 6, 2010
Citation(s):
Sordé R et al. Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy. Arch Intern Med 2010 Sep 27; [e-pub ahead of print]. (http://dx.doi.org/10.1001/archinternmed.2010.347)
https://docs.google.com/fileview?id=0B278nGJMQBk7ZDBkNTEyYzgtOWJjNi00YjJiLWFmZjgtMmQxNGIzNTM4ZmE0&hl=zh_TW
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