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Original Research: Chest Infections |

Invasive Disease vs 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

FUNDING/SUPPORT: This study was sponsored by Pfizer. I. C. reports personal fees from Pfizer S.L.U., during the conduct of the study, and personal fees from Pfizer S.L.U., outside the submitted work; C. M. reports personal fees from Pfizer S.L.U., during the conduct of the study, and personal fees from Pfizer S.L.U., outside the submitted work. A. C. is the recipient of an ERS Long Term Fellowship. C. C. is the recipient of an ERS Short Term Fellowship.

aDepartment of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain

bSección Neumología, Hospital Nacional Alejandro Posadas, El Palomar, Argentina

cDepartment of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain

dFacultad de Enfermería, Universidad de Valladolid, Valladolid, Spain

eMedical Department, Pfizer S.L.U., Madrid, Spain

fDepartment of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain

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

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

CORRESPONDENCE TO: Antoni Torres, MD, PhD, Department of Pneumology, Hospital Clinic of Barcelona, Villarroel 140, Barcelona 08036, Spain


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(6):1311-1319. doi:10.1016/j.chest.2017.01.005
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Background  The burden of pneumococcal disease is measured only through patients with invasive pneumococcal disease. The urinary antigen test (UAT) for pneumococcus has exhibited high sensitivity and specificity. We aimed to compare the pneumococcal pneumonias diagnosed as invasive disease with pneumococcal pneumonias defined by UAT results.

Methods  A prospective observational study of consecutive nonimmunosuppressed patients with community-acquired pneumonia was performed from January 2000 to December 2014. Patients were stratified into two groups: invasive pneumococcal pneumonia (IPP) defined as a positive blood culture or pleural fluid culture result and noninvasive pneumococcal pneumonia (NIPP) defined as a positive UAT result with negative blood or pleural fluid culture result.

Results  We analyzed 779 patients (15%) of 5,132, where 361 (46%) had IPP and 418 (54%) had NIPP. Compared with the patients with IPP, those with NIPP presented more frequent chronic pulmonary disease and received previous antibiotics more frequently. Patients with IPP presented more severe community-acquired pneumonia, higher levels of 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 with the 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 was 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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