Korean J Clin Microbiol.  2010 Mar;13(1):14-18. 10.5145/KJCM.2010.13.1.14.

Investigation of Positive Streptococcus pneumoniae Urinary Antigen Test Results in a Korean University Hospital

• Kim IS
• Koh EH
• Kim S
• Maeng KY
• Jung HJ

• KMID: 1828590
• DOI: http://doi.org/10.5145/KJCM.2010.13.1.14

Abstract

BACKGROUND
The Streptococcus pneumoniae urinary antigen test (SPUAT) (Binax Now, USA) was developed for detecting polysaccharide C in urine samples for rapid diagnosis of pneumococcal pneumonia, the most common cause of community-acquired pneumonia (CAP). To validate positive results of these tests, we retrospectively investigated all positive results obtained from the emergency room of a Korean university hospital among patients with suspected CAP.
METHODS
One hundred twenty-three positive SPUAT results were abstracted and analyzed from the authors' laboratory information system among the SPUAT results performed from 1,143 pneumonic patients admitted from the emergency room of a university hospital between 2007 and 2008. Medical records, including conventional microbiologic analysis results, were reviewed in detail for all positive test results.
RESULTS
Among 123 patients with the positive SPUAT results, 24 patients were excluded due to hospitalization history during the preceding month. Nine of 99 patients (9.1%) with suspected CAP had confirmed pneumococcal pneumonia upon conventional sputum or blood culture. Thirty-five positive results (35.4%) showed other microorganisms upon conventional methods, which might be due to possible cross-reactivity. Among those, 23 positive results were considered bacterial pneumonic agents, and 12 positive results were regarded as urinary tract infection strains or contaminating agents. Fifty-five positive SPUAT results (55.6%) showed negative conventional microbiologic growth, and some positive SPUAT results might be caused by true pneumococcal infection although without cultural evidence.
CONCLUSION
Our retrospective study demonstrated that a positive SPUAT result typically does not agree well with conventional culture methods, suggesting that the value of a positive SPUAT result in etiology determination may be limited under practical conditions in a university hospital.

Keyword

Streptococcus pneumoniae; Bacterial antigens; Urinary antigen test; Cross-reactivity

MeSH Terms

Antigens, Bacterial
Clinical Laboratory Information Systems
Emergencies
Hospitalization
Humans
Medical Records
Pneumococcal Infections
Pneumonia
Pneumonia, Pneumococcal
Retrospective Studies
Sputum
Streptococcus
Streptococcus pneumoniae
Urinary Tract Infections
Antigens, Bacterial

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