The aim of the present study was to investigate the predictors of targeted therapy (TT) for pneumococcal community-acquired pneumonia (PCAP) with a positive urinary antigen test (UAT) and compare the outcomes with those of nontargeted therapy. This prospective cohort study enrolled consecutive PCAP patients with a positive UAT who were hospitalized at Kurashiki Central Hospital from October 2010 to November 2019. A total of 286 patients were included. Of them, 56 patients (19.6%) were included in the TT group. On multivariate analysis, identification of Gram-positive diplococci by Gram stain (OR [95% CI]: 2.46 [1.32-4.63]) was a positive predictor, whereas aspiration pneumonia (0.17 [0.03-0.59]) and CURB-65 score (0.59 [0.42-0.81]) were negative predictors of TT. Initial treatment failure and 30-day mortality were not significantly different. The UAT is not used enough for TT, and TT for PCAP did not have worse outcomes.
Keywords: Community-acquired pneumonia; pneumococcal pneumonia; targeted therapy; urinary antigen test. Abbreviations: Binax, Binax NOW S. pneumoniae urinary antigen test kit CAP, community-acquired pneumonia CURB-65, confusion, urea >7 mmol/L, respiratory rate ≥30 breaths per minute, low blood pressure (systolic <90 mm Hg or diastolic ≤60 mm Hg), and age ≥65 years IPTW, inverse probability of treatment weighting PSI, Pneumonia Severity Index PUAT, pneumococcal urinary antigen test UAT, urinary antigen test.
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