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Original Research |

Invasive Disease versus Urinary Antigen Confirmed Pneumococcal Community-Acquired Pneumonia

Adrian Ceccato, MD; Antoni Torres, MD, PhD; Catia Cilloniz, PhD; Rosanel Amaro, MD; Albert Gabarrus, MSc; Eva Polverino, MD, PhD; Elena Prina, MD; Carolina Garcia- Vidal, MD, PhD; Eva Muñoz-Conejero, PhD; Cristina Mendez, MD; Isabel Cifuentes, MD; Jorge Puig de la Bella Casa, MD; Rosario Menendez, MD, PhD;; Michael S. Niederman, MD.
Author and Funding Information

Conflict of interest: Dr. Cifuentes reports personal fees from Pfizer S.L.U., during the conduct of the study; personal fees from Pfizer S.L.U., outside the submitted work; Dr. Méndez reports personal fees from Pfizer S.L.U., during the conduct of the study; personal fees from Pfizer S.L.U., outside the submitted work. The authors declare they have no other disclosure to report.

Financial support: This study was sponsored by Pfizer. Adrian Ceccato is recipient of ERS Long Term Fellowship. Catia Cillóniz is recipient of ERS Short Term Fellowship.

1Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona Spain

2Seccion Neumologia, Hospital Nacional Alejand\ro Posadas, Palomar Argentina

3Departments of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona Spain

4Facultad de Enfermeria, Universidad de Valladolid, Valladolid Spain

5Medical Department, Pfizer S.L.U., Madrid, Spain

6Department of Microbiology, Hospital Clinic of Barcelona, Barcelona Spain

7Department of Pneumology, IIS/Hospital Universitario y Politécnico La Fe, CIBERES, Valencia Spain

8Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian/Weill Cornell Medical Center, New York, NY

Corresponding author: Professor Antoni Torres Department of Pneumology, Hospital Clinic of Barcelona Villarroel 140, Barcelona (08036), Spain.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.01.005
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Abstract

Objectives  The burden of pneumococcal disease is measured only through patients with invasive pneumococcal disease. The urinary antigen test (UAT) for pneumococcus has exhibited a high sensitivity and specificity. We aimed to compare the pneumococcal pneumonias diagnosed as invasive disease with pneumococcal pneumonias defined by UAT.

Methods  Prospective observational study on consecutive non-immunosuppressed patients with community-acquired pneumonia from January 2000 to December 2014. Patients were stratified in 2 groups: Invasive pneumococcal pneumonia (IPP) defined as a positive blood culture or pleural fluid culture and non-invasive pneumococcal pneumonia (NIPP) defined as a positive UAT with blood or pleural fluid culture negative.

Results  We analyzed 779 (15%) patients out of 5,132 where 361 (46%) had IPP and 418 (54%) were NIPP. Compared with IPP cases, the NIPP cases presented more frequent chronic pulmonary disease and received previous antibiotics more frequently. IPP patients presented more severe CAP, higher 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 to 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 were an independent risk factor for 30-day mortality.

Conclusions  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.


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