Invasive Vs Urinary Antigen Test-Confirmed CAP

Invasive Vs Urinary Antigen Test-Confirmed CAP

Data indicate that Streptococcus pneumoniae is the most common bacterial cause of pneumonia, making it an important target for health policy. However, the burden of pneumococcal disease is currently measured only through patients with invasive pneumococcal disease. While previous studies suggest that the urinary antigen test (UAT) for pneumococcus exhibits high sensitivity and specificity, comparisons of pneumococcal pneumonias diagnosed as invasive disease with pneumococcal pneumonias defined by UAT results are lacking.   Comparing Patients by Diagnostic Method For a study published in Chest, Adrian Ceccato, MD, and colleagues aimed to compare the clinical characteristics and outcomes of pneumococcal pneumonias diagnosed as classical “invasive disease” with pneumococcal pneumonias defined by UAT. “UATs have high sensitivity and specificity and can be performed at the point of care,” says Dr. Ceccato. “In spite of these favorable properties, they have not been incorporated in estimations of pneumococcal disease burden.” The prospective, observational study included consecutive patients with community-acquired pneumonia (CAP) who visited emergency departments in Barcelona, Spain between January 2000 and December 2014. Participants were adults with a CAP diagnosis confirmed by chest radiograph and consistent clinical manifestations (eg, fever, cough, sputum production, pleuritic chest pain). Pneumococcal etiology was confirmed by UAT or by blood or pleural fluid culture. “We found that a high percentage of cases of confirmed pneumococcal pneumonia are diagnosed by UAT,” explains Dr. Ceccato. “When we compared patients with invasive pneumococcal pneumonia (IPP) with patients with noninvasive pneumococcal pneumonia (NIPP) diagnosed only by UAT, we found clinical and evolutionary differences, including a higher severity of the disease in the IPP group. However, neither IPP nor NIPP were independently associated...
Losing Ground Against Gonorrhea – The Rising Antibiotic Resistance

Losing Ground Against Gonorrhea – The Rising Antibiotic Resistance

The following was originally posted to the University of Nebraska Medical Center, Division of Infectious Diseases Blog.   April is Sexually Transmitted Infection (STI) Awareness month  and there is a critical need to raise awareness toward preventing these infections in all our patients. In the past, most STIs were easily treated with readily available antibiotics, but unfortunately, the story of Gonorrhea has taken a turn down a frightening road. Gonorrhea is the 2nd most commonly reported transmissible disease and therefore carries recommendations for annual screening among sexually active women < 25 years old and as needed screening for at-risk men and women with unprotected sexual encounters. Testing is simple and done with swabs or urine testing. Sexual partners within the last 60 days are at risk for infection and should be contacted and advised to seek medical care and presumptive treatment. The most recent CDC guidelinesrecommend treatment with both ceftriaxone and azithromycin, however, these options are starting to run out. In late March, the UK reported a case of drug-resistant Gonorrhea acquired in southeast Asia that was resistant to, and failed treatment with, first line antibiotics (ceftriaxone and azithromycin) for Gonorrhea. Reports of ceftriaxone resistance have already been reported in several countries. The risk of the eventual emergence of untreatable Gonorrhea is real – and terrifying. The CDC has been monitoring, and working to prevent, the evolution of drug-resistant Gonorrhea since the 1980’s but it appears we are losing the battle. Resistance has been increasing overtime, with the loss of fluoroquinolones already complicating our current treatment strategies. If cephalosporin and macrolide resistance increase in prevalence, the treatment options are dismal. So, where do we go from...
Page 1 of 4812345...Last »