Analysis of period of positive urinary antigen detection kit for Streptococcus pneumoniae in patients with pneumococcal pneumonia]

The objectives of this study were to investigate the usefulness of the urinary antigen detection kit for Streptococcus pneumoniae and to analyze the duration of urinary antigen presence in pneumococcal pneumonia. We evaluated this kit in 51 patients whose symptoms and laboratory data suggested pneumococcal pneumonia and who were admitted to Toho University Hospital (Tokyo, Japan) between July 2000 and June 2001. S. pneumoniae urinary antigen was detected in 21 of 51 patients. These 21 patients were further investigated with their clinical characteristics and the duration of a positive urinary antigen reaction. S. pneumoniae was isolated by sputum or blood culture in 10 cases (47.6%), whereas 11 cases (52.4%) showed positive results only with urinary antigen but not in cultures. When the urinary antigen kits were tested, 19 cases (90.5%) were treated with antibiotics. Eleven of the 21 patients were continuously tested with this kit. The mean duration for which these patients were urinary antigen-positive was 7.3 weeks. Patients whose pneumonia was severe or who had positive culture results tended to be positive for urinary antigen for a prolonged period. This kit has high sensitivity and specificity, is suitable for rapid diagnosis and is effective after antibiotic therapy. However, because the positive test kit results are prolonged after recovery from pneumonia in some cases, this kit is not suitable for the evaluation of therapeutic effect.     

Usefulness of Streptococcus pneumoniae urinary antigen detection kit and the duration and intensity of reactivity with urinary antigen in patients with pneumonia]

We evaluated a rapid urinary antigen detection kit, Binax Now Streptococcus pneumoniae (Binax Inc., USA), which detects S. pneumoniae antigen in urine by immunochromatographic membrane assay, in 379 patients with presumptive pneumonia (total: 454 urine samples). S. pneumoniae antigen was detected in 64 (34%) of 188 patients. In all 64, pneumonia was diagnosed clinically, and there were 11 intense reactivity cases, 27 intermediate cases, and 26 weak cases. We found only two patients with positive sputum cultures for S. pneumoniae among 26 patients with weak reactivity to urinary antigen. The weak urinary antigen reactivity seems to include a false-positive result for S. pneumoniae pneumonia. There were five patients with negative results in whom S. pneumoniae was isolated (false-negative). We took intense and intermediate reactivity to be positive in order to diagnose pneumococcal pneumonia, and the kit showed a sensitivity of 72% and a specificity of 94% in 379 patients. The urinary antigen kit allowed us to diagnose 80% more patients with pneumococcal pneumonia than the use of conventional bacteriological diagnosis alone. There was no significant difference in the initial clinical characteristics, or in the severity of pneumonia among the three groups, according to the color intensity reached using the kit--weak, intermediate, and intense for the reactivity of urinary antigen. The duration of reactivity with S. pneumoniae urinary antigen did not correlate with the clinical characteristics or the severity of pneumonia. We concluded that S. pneumoniae urinary antigen detection kit is a useful adjunct to culturing for determining the etiology of pneumonia.     

Evaluation of rapid urinary antigen test kit for Streptococcus pneumoniae in children with pneumonia or meningitis

We evaluated rapid urinary antigen test kit for Streptococcus pneumoniae (Binax NOW S. pneumoniae) in 85 inpatients between February 2002 and November 2002. Diseases of patients were pneumonia in 82 and meningitis in 3. The age range of the patients was from 4 months to 14 years. We studied urinary antigen assay and culture of nasopharyngeal swab in all patients. Three infants with meningitis were measured liquor by the kit. Two infants with meningitis due to S. pneumoniae showed positive reactions in urine and liquor, but result of 1 infant with meningitis due to Haemophilus influenzae was negative. Of 82 patients with pneumonia, S. pneumoniae was isolated from 52 patients and the urinary antigen test was positive in 39. Thirty-eight patients were isolated S. pneumoniae in 39 positive patients and 14 children were isolated it in 44 negative patients. Sensitivity in this test kit was 73.1% and specificity was 96.8%. This test is useful for children as well as adults.     

Dual infection with Streptococcus pneumoniae and Mycobacterium tuberculosis in HIV-seropositive patients with community acquired pneumonia.

Pulmonary infections with more than one organism are common in human immunodeficiency virus (HIV) seropositive patients. We describe nine cases of dual infection with Streptococcus pneumoniae and Mycobacterium tuberculosis in HIV-seropositive patients presenting with community acquired pneumonia (CAP). It is important to exclude pulmonary tuberculosis in HIV-seropositive patients with CAP who fail to respond appropriately to initial antibiotic therapy, even if another etiological pathogen has been found.     

Diagnostic procedures for patients with community acquired pneumonia

The diagnosis of community acquired pneumonia (CAP) is based on a patient history with respiratory symptoms and additional symptoms and signs such as fever over more than 4 days, dyspnea and tachypnea and/or a positive lung auscultation. Despite recently developed tests, radiology is a key diagnostic procedure for confirming CAP. Importantly, the first treating physician must judge whether to hospitalize a patient or not. Two major scoring systems allow judgement of severity and short-term prognosis. In general, in patients with mild or moderate pneumonia who can be treated on an ambulatory basis, no specific microbiological diagnosis must be performed. If, for clinical or epidemiological reasons a gram stain is done, it must be obtained from purulent sputum. Recent tests may help in discriminating between viral and bacterial pneumonia (procalcitonin test) or determine the bacteria responsible for acute disease (pneumococcal antigen test using urine).     

不同时期老年社区获得性肺炎患者不典型病原检测结果分析

目的 调查3个时期老年社区获得性肺炎(CAP)住院患者病毒、支原体、衣原体及军团菌感染状况,为临床流行病学研究提供参考. 方法 选取2001年10月至2004年6月[称为围严重急性呼吸综合征(SARS)期]、2005年7月至2007年10月及2008年1月至2010年12月(称为围甲流期)于河北联合大学附属医院住院的492例老年患者作为研究对象,于入院当天及入院后7～10d行血清支原体、衣原体、军团菌IgM抗体及7种常见病毒IgM抗体检查,对3个期间的资料进行分析. 结果 492例患者支原体IgM抗体阳性80人次(16.26％)、衣原体IgM抗体阳性46人次(9.35％)、军团菌IgM抗体阳性25人次(5.08％)、病毒IgM抗体阳性118人次(23.99％).“围SARS期”不典型病原体总检出率及军团菌、合胞病毒、巨细胞病毒、单纯疱疹病毒及风疹病毒检出率明显高于其他2个时期.不典型病原体抗体在起病20d内的检出率较高. 结论 不典型病原体仍为老年CAP的重要致病原,其中以支原体感染最为常见.前后对比围SARS期间病毒感染更为普遍.老年CAP患者不典型病原体感染率无明显上升,部分有下降趋势.在起病20 d内多数不典型病原体感染患者IgM抗体可检出阳性.     

Evaluating the use of a Streptococcus pneumoniae urinary antigen detection kit for the management of community-acquired pneumonia in Japan

BACKGROUND: The urinary antigen detection kit for Streptococcus pneumoniae was tested. OBJECTIVES: It was our aim to evaluate the usefulness of the immunochromatographic membrane test by doing a large prospective study of community-acquired pneumonia (CAP) in Japan. METHODS: We prospectively evaluated the use of the S. pneumoniae urinary antigen detection kit and analyzed the treatment and clinical effect seen in patients with positive test kit results. One hundred and fifty-six patients with CAP admitted to our hospital between October 2001 and September 2003 were evaluated. RESULTS: In 49% of these CAP patients, the causative microorganisms were isolated. S. pneumoniae was suspected to be the causative microorganism in 15%, but positive results of the urinary antigen detection kit indicated S. pneumoniae to be a probable microorganism in 28%, even though antibiotics had previously been administered to half of the patients. The kit was particularly useful for diagnosing patients with poor quality sputum in whom antibiotics treatment nevertheless had to be selected. Antibiotics appropriate for S. pneumoniae (mainly penicillin) were given. The treatment was found to have excellent clinical results in 89% of the CAP patients. CONCLUSIONS: The S. pneumoniae urinary antigen detection kit was considered to be useful in selecting treatment since there was a high level of clinical effectiveness when the most suitable antibiotics were immediately administered to positive patients. The use of the S. pneumoniae urinary antigen kit is rapid and simple compared with conventional microbiological procedures.     

老年人社区获得性肺炎病原学的调查

目的探讨老年人社区获得性肺炎（CAP）发病相关的主要因素及病原学特点。方法对151例老年人CAP住院患者,总结其基础疾病及其病原学分布特点。结果老年人CAP住院患者多有基础疾病,病原学检查检出率为76．1％,致病菌以G-杆菌为主,检出率依次为肺炎克雷白杆菌、肺炎链球菌、铜绿假单胞菌、大肠埃希菌,流感嗜血杆菌、非典型致病菌等。结论老年人CAP住院患者基础疾病多、临床表现不典型、病原菌复杂,应当引起临床医生的高度重视。     

Comparing the pneumonia severity index with CURB-65 in patients admitted with community acquired pneumonia

Pneumonia severity assessment systems such as the pneumonia severity index (PSI) and CURB-65 were designed to direct appropriate site of care based on 30-d mortality. Increasingly they are being used to guide empirical antibiotic therapy and also possibly to detect patients who will require admission to the intensive care unit (ICU). We retrospectively reviewed the records of all patients admitted to our institution with confirmed community acquired pneumonia (CAP) for the 12 months from January 2002. 408 episodes were studied with an overall 30-d mortality of 15.4% and ICU admission of 10.5%. PSI classes IV/V were significantly better than CURB-65 score > or = 3 for predicting patients who died within 30 d (94% vs 62%; p < 0.001), and those that needed ICU (86% vs 61%; p = 0.01). In addition, for the patients identified as 'low risk' by PSI (classes I/II), there was only 1 death and 1 admission to an ICU compared to 8 deaths and 7 ICU admissions with CURB-65 scores of 0-1. Although easier to use, CURB-65 is neither sensitive nor specific for predicting mortality in CAP patients. Neither rule was sufficiently accurate for predicting need for an ICU, even when patients with 'not for resuscitation' orders were excluded.     

成人社区获得性肺炎中肺炎支原体的耐药性探讨

目的 采用肺炎支原体（MP）分离培养-药敏法初步探讨住院成人社区获得性肺炎（CAP）中MP的耐药状况,为临床抗菌药物选择提供依据.方法 选取住院的成人CAP患者2859例,取咽拭子标本培养检测MP;对MP阳性标本行药敏检测,观察MP对红霉素、罗红霉素、阿奇霉素、四环素、米诺环素、多西环素、环丙沙星、左氧氟沙星、加替沙星、莫西沙星等10种药物的耐药情况.结果 咽拭子培养MP阳性575例,占20.11％;MP对红霉素等大环内酯类药物耐药率达54.9％ ～ 62.0％,对加替沙星、莫西沙星耐药率为10.0％ ～21.3％.结论 MP是成人CAP的重要病原体,应加强耐药性监测,合理选择抗菌药物.     

经验性抗感染治疗急诊病房社区获得性肺炎疗效评价

目的评价急诊病房经验性抗感染治疗社区获得性肺炎（CAP）的临床疗效。方法以急诊病房CAP患者为研究对象,依据低、中、高危人群前瞻性应用抗感染治疗方案（阿奇霉素或左氧氟沙星、或联合二、三、四代头孢）,评价其疗效。结果92例患者中,男63例（68．5％）／女29例（31．5％）,年龄69．1±16．7（14～99）岁,其中CAP60例（65．2％）,CAP伴胸膜炎18例（19．6％）,慢性阻塞性肺疾病急性加重（AECOPD）伴CAP8例（8．7％）,AECOPD合并CAP伴胸膜炎4例（4．4％）,支气管扩张合并CAP2例（2．2％）。所有患者中,低危人群28例（30．4％）,中危人群34例（37．0％）,高危人群30例（32．6％）。在几种治疗方案中,7d好转率（有效／显效）为60．9％（56例）、临床治愈率为38．0％（35例）,总有效率（好转＋治愈）为98．9％（91例）。14d治愈率为47．8％（44例）,21d治愈率为10．9％（10例）。结论依据低、中、高危人群单独选择阿奇霉素或左氧氟沙星、或联合二、三、四代头孢类抗菌药物,经验性抗感染治疗CAP疗效确切可靠。     

A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia.

Nursing home acquired pneumonia (NHAP) is thought to be clinically distinct from community acquired pneumonia (CAP). This observation, based on studies conducted mainly in North America, may not be relevant in countries with a different healthcare system. The authors describe an 18-month prospective cohort study of 437 patients admitted to hospital with CAP, 40 (9%) of whom came from nursing homes. Detailed microbiological tests were performed in a subset of patients over 12 months. Patients with NHAP were less likely to have a productive cough (odds ratio (OR) 0.4, p=0.02) or pleuritic pain (OR 0.1, p=0.03), but they were more likely to be confused (OR 2.6, p<0.001). They had poorer functional status (p<0.001) and more severe disease (p=0.03). Mortality was higher compared to CAP (53% versus 13%), but this was mainly explained by prior functional status (OR 0.5, after adjustment for functional status). Pathogens were identified in 68% of 22 NHAP and 80% of 44 matched CAP patients. Streptococcus pneumoniae was the most common (55% NHAP, 43% CAP). Atypical pathogens, enteric Gram negative bacilli and Staphylococcus aureus were uncommon. In conclusion, differences in functional status accounted for the increased mortality in nursing home acquired pneumonia compared to community acquired pneumonia. The pathogens implicated were similar. No grounds for a difference in choice of empirical antibiotics were apparent.     

Treatment of community acquired pneumonia

The S3 guidelines for diagnosis and therapy use German epidemiological data to set the standards for a risk and degree of severity based treatment of community acquired pneumonia (CAP). Over the last few years, a change in pathogen epidemiology has been recognized with the significance of staphylococci and enterobacteria increasing. CAP is becoming increasingly a disease of the elderly, for whom a more broadly effective initial therapy appears to be needed. Resistant pathogens play an important role in the course of the disease. For patients with a low risk of mortality, a reduction in the length of therapy seems possible. On the other hand, the early identification of critically ill patients who require treatment with high dose, broad spectrum antibiotics is necessary. Antibiotic associated diarrhoea, caused by Clostridium difficile, is a significant complication in antibiotic therapy. With the introduction of vaccination against Streptococcus pneumoniae for children, a change in the course of the illness and an improvement in the resistance situation has been achieved. An update of the S3 guidelines is intended for 2008 in order to integrate new knowledge into the recommendations.     

Validation of urinary antigen test for Streptococcus pneumoniae in patients with pneumococcal pneumonia

The study was undertaken to prospectively evaluate a Streptococcus pneumoniae urinary antigen test for diagnosis of pneumococcal pneumonia among patient and control groups between 2004 and 2006. Microbiological analysis for these patients included Gram staining for sputum, sputum and blood culture. Nonconcentrated urine samples were tested using an immunochromatographic assay, the NOW S.pneumoniae antigen test. The urinary antigen test was positive in 9 (15.3%) of 59 patients enrolled in the study and in 8 (73%) of 11 patients with pneumococcal pneumonia confirmed by conventional methods. The test revealed a sensitivity of 72.7% and a specificity of 97.6% with conventional microbiological criteria used as the reference standard. The positive predictive value was 88.9% and the negative predictive value was 93%. We concluded that the urinary antigen test can supplement conventional microbiological tests in the diagnosis of pneumococcal pneumonia.     

铜陵地区成人社区获得性肺炎临床特征

目的了解铜陵地区社区获得性肺炎的临床特征。方法调查2006年1月至2009年1月铜陵地区272例社区获得性肺炎的临床资料。结果272例CAP患者中男155例（57．0％）,女117例（43．0％）,平均年龄（55．9±13．5）岁。发热者183例（67．3％）;咳嗽咳痰206例（75．7％）;咯血57例（21．0％）;胸痛31例（11．4％）;胸闷25例（9．2％）;外周血WBC〉10×10^9／L者68例（25．0％）,〈4．0×10^9／L者21例（7．7％）;有肝功能损害45例（20．2％）;存在基础疾病者63例（23．2％）;病变局限于一个肺叶或肺段者184例（67．6％）,双侧或多叶受累者88例（32．4％）;合并单侧或双侧胸腔积液者43例（15．8％）;重症肺炎13例（4．8％）;入选前使用抗菌药物87例（32．0％）;272例CAP患者共分离细菌66株,其中肺炎链球菌和肺炎克雷伯杆菌是最常见的病原体。结论CAP临床表现不典型,在临床工作中应高度重视,尽早进行胸片或肺CT检查,以明确诊断。     

社区获得性肺炎中的混合感染

社区获得性肺炎(CAP)中的混合感染正逐渐受到人们的关注,但是对其尚无统一认识。文章就CAP混合感染的流行病学特点、临床表现及治疗预后进行综述。CAP混合感染的发生率变异很大(2.5%~38.0%)。中国混合感染的发生率为11.5%。CAP的混合感染以细菌合并不典型病原体最为常见。最常见的混合感染细菌为肺炎链球菌;最常见的不典型病原体国外为衣原体、中国为支原体;最常见的混合感染病毒为流感病毒。除具有CAP的一般特点外,混合感染的CAP患者并没有特异性临床表现。在CAP经验性治疗的抗菌药物选择中应该关注混合感染,推荐头孢菌素和大环内酯类抗生素联合治疗或选择呼吸喹诺酮类药物。不推荐初始经验性治疗是否加用抗病毒药物。CAP混合感染与患者的死亡率无关,不会影响预后。     

Performance status and in-hospital mortality of elderly patients with community acquired pneumonia

To evaluate the role of performance status evaluated by the Eastern Cooperative Oncology Group (ECOG) score in predicting 30-day mortality in subjects hospitalized for community acquired pneumonia (CAP), this was a prospective study of patients consecutively hospitalized for CAP at a large University Hospital in Italy. Performance status was evaluated using the ECOG score that in a 0–5 point scale indicates progressive functional deterioration. The end-point of the study is the 30-day mortality. Two-hundred-sixteen patients were enrolled, 75.9% were aged?>?70 years, 31.5% had severe pneumonia at CURB-65 score (3–4), and 27.5% of patients had severe disability (ECOG 3–4). Thirty-day mortality is 15.3%. Progression in ECOG score independently increases the probability of 30-day mortality at multivariable logistic regression analysis (HR 2.19, 95% CI 1.60–3.01, p?<?0.0001). ECOG 3 or 4 determines a four-fold increase in 30-day mortality (HR 4.07, 95% CI 1.84–9.02, p?<?0.001). ECOG score 3 or 4 is highly predictive of death in patients classified at low risk of mortality by CURB-65 (0–2 points) score. Functional status is directly related to outcome in elderly patients hospitalized for CAP. The use of a very simple and fast tool, such as the ECOG score, might help to better stratify the risk of short-term mortality, especially in patients otherwise classified at low risk of death by CURB-65 score.