Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia

Falguera, Miquel; Ruiz-González, Agustı́n; Schoenenberger, Juan Antonio; Touzón, Carlos; Gázquez, I; Galindo, Carlos; Porcel, José M.

doi:10.1136/thx.2009.118588

Cited by 111 publications

(88 citation statements)

References 25 publications

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“…This study was designed to compare an empirical vs a targeted treatment on the basis of urine antigen results in hospitalized patients with CAP. The authors 15 did not find differences between these 2 strategies in terms of clinical outcomes or economic benefits. Moreover, they observed some clinical relapse in patients who received a targeted therapy that might be due to uncovered agents in some potential mixed infections.…”

Section: Commentmentioning

confidence: 97%

Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

Sordé¹,

Falcó²,

Lowak³

et al. 2011

Arch Intern Med

106

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Section: Commentmentioning

confidence: 97%

Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

Sordé¹,

Falcó²,

Lowak³

et al. 2011

Arch Intern Med

106

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“…Two randomized controlled trials (51,52) and two observational studies (24,33) have examined the impact of use of BinaxNOW-SP in treatment decision-making on outcomes in hospitalized patients. In the randomized controlled trials, patients were randomized to empirical or targeted therapy, and those receiving targeted therapy who tested positive with BinaxNOW-SP received therapy specific for S. pneumoniae.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of a Urine-Based Pneumococcal Antigen Test for Diagnosis of Community-Acquired Pneumonia Caused by Streptococcus pneumoniae

et al. 2013

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Standard culture methods for diagnosis of Streptococcus pneumoniae pneumonia take at least 24 h. The BinaxNOW urine-based test for S. pneumoniae (BinaxNOW-SP) takes only 15 min to conduct, potentially enabling earlier diagnosis and targeted treatment. This study was conducted to assess whether the use of BinaxNOW-SP at the time of hospital admission would provide adequate sensitivity and specificity for diagnosis of community-acquired pneumonia (CAP) in adult patients. We searched PubMed, EMBASE/OVID, Cochrane Collaboration, Centre for Reviews and Dissemination, INAHTA, and CADTH for diagnostic or etiologic studies of hospitalized predominately adult patients with clinically defined CAP that reported the diagnostic performance of BinaxNOW-SP versus cultures. Two authors independently extracted study details and diagnostic two-by-two tables. We found that 27 studies met our inclusion criteria, and three different reference standards were used between them. A bivariate meta-analysis of 12 studies using a composite of culture tests as the reference standard estimated the sensitivity of BinaxNOW-SP as 68.5% (95% credibility interval [CrI], 62.6% to 74.2%) and specificity as 84.2% (95% CrI, 77.5% to 89.3%). A meta-analysis of all 27 studies, adjusting for the imperfect and variable nature of the reference standard, gave a higher sensitivity of 74.0% (CrI, 66.6% to 82·3%) and specificity of 97.2% (CrI, 92.7% to 99.8%). The analysis showed substantial heterogeneity across studies, which did not decrease with adjustment for covariates. We concluded that the higher pooled sensitivity (compared to culture) and high specificity of BinaxNOW-SP suggest it would be a useful addition to the diagnostic workup for community-acquired pneumonia. More research is needed regarding the impact of BinaxNOW-SP on clinical practice. Streptococcus pneumoniae pneumonia is believed to be the most common cause of community-acquired pneumonia (CAP) in adults, which in turn is the most common infection-related cause of death in developed countries (1). Diagnosis is usually established by observation of S. pneumoniae in a Gram-stained sputum sample or growth of S. pneumoniae in a culture of blood, sputum, pleural fluid, or other respiratory sample. Although highly specific, culturing is known to be insensitive, with diagnostic yields reported to be Ͻ30% for blood culture (2-7) and 57% for sputum culture (the latter in patients who had an etiologic diagnosis established) (8). Cultures also require 24 h or more to produce results. In the absence of a reliable rapid test for pneumonia caused by S. pneumoniae, initial treatment of pneumonia must be empirical, based upon knowledge of local pathogens, patient risk factors and comorbidities, and severity of presentation (7). Empirical therapy is generally effective (7), but there is increasing interest in improved targeting of antibiotics, due to the understanding that this may decrease the community prevalence of antibiotic-resistant bacteria and individual risks of antibiotic-associated Clostridium ...

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“…The second study was a RCT evaluating the effect of urinary antigen-based targeted antibiotic therapy [41]. All clinical and economic outcomes were similar in the two arms in the intention-to-treat (ITT) analysis.…”

Section: Streamlining Based On Urinary Antigen Testingmentioning

confidence: 99%

Modern Management of Community-Acquired Pneumonia: Is It Cost-Effective and are Outcomes Acceptable?

Mertz

Johnstone

2011

Curr Infect Dis Rep

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Community-acquired pneumonia (CAP) is the most important cause of death from infectious diseases in the developed world and is associated with a high economic burden. Researchers have therefore sought ways to improve CAP outcomes while reducing costs. In this review, we highlight the current evidence supporting modern approaches to CAP management, including the use of severity indices to safely increase the proportion of patients treated at home, the use of procalcitonin to decrease antibiotic use, early intravenous to oral switch of antibiotic therapy, streamlining antimicrobials, and approaches to shorten antibiotic treatment duration. Although promising evidence exists for these modern strategies, there is still a considerable lack of high-quality evidence proving noninferiority of clinical outcomes and cost-effectiveness.

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Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia

Cited by 111 publications

References 25 publications

Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

Systematic Review and Meta-Analysis of a Urine-Based Pneumococcal Antigen Test for Diagnosis of Community-Acquired Pneumonia Caused by Streptococcus pneumoniae

Modern Management of Community-Acquired Pneumonia: Is It Cost-Effective and are Outcomes Acceptable?

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