Performance measure of urinary antigen in patients with Streptococcus pneumoniae bacteremia

Selickman, John; Paxos, Mihail; File, Thomas M.; Seltzer, Ryan; Bonilla, Hector

doi:10.1016/j.diagmicrobio.2010.01.005

« Previous Next »Diagnostic Microbiology & Infectious Disease
Volume 67, Issue 2 , Pages 129-133, June 2010

Performance measure of urinary antigen in patients with Streptococcus pneumoniae bacteremia☆

John Selickman
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN 55455, USA
- Corresponding authors. John Selickman is to be contacted at 821 Douglas Ave, Unit 105, Minneapolis, MN 55403, USA. Tel.: +1-651-955-6311. Hector Bonilla, 75 Arch Street #105, Akron, OH 44304, USA. Tel.: +1-330-375-3894.
Mihail Paxos
- Department of Internal Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
Thomas M. File Jr.
- Northeastern Ohio Universities College of Medicine, Rootstown, OH 44272, USA
- Department of Internal Medicine, Summa Health System, Akron, OH 44304, USA
Ryan Seltzer
- HealthCare Partnership, Department of Psychology, The University of Arizona, Tucson, AZ 85719, USA
Hector Bonilla
- Northeastern Ohio Universities College of Medicine, Rootstown, OH 44272, USA
- Department of Internal Medicine, Summa Health System, Akron, OH 44304, USA
- Corresponding authors. John Selickman is to be contacted at 821 Douglas Ave, Unit 105, Minneapolis, MN 55403, USA. Tel.: +1-651-955-6311. Hector Bonilla, 75 Arch Street #105, Akron, OH 44304, USA. Tel.: +1-330-375-3894.

Received 15 September 2009; accepted 13 January 2010. published online 25 March 2010.

Abstract

The Streptococcus pneumoniae (SP) urinary antigen (UAg) test is a commonly used assay. The purpose of this study was to evaluate the test's actual performance in the clinical setting and determine the effects of renal function, grade of bacteremia, and severity-of-illness scores on its outcome. Patients with pneumococcal bacteremia were retrospectively identified and stratified on the basis of glomerular filtration rates, number of positive blood cultures, and CURB-65 scores. Logistic regression was used to determine the effect that these 3 variables had on test outcomes. SP UAg testing was performed in 65 of 129 patients with pneumococcal bacteremia and was positive in 42 of 65 (64.5%). Impaired renal function was the only variable to have a significant effect on test outcome (P = 0.03). Test performance was less sensitive than prospective studies indicate. Patients with impaired renal function were significantly more likely to have positive UAg tests.

Keywords: Streptococcus pneumoniae, Urinary antigen, Bacteremia, Diagnosis