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Всемирные руководства рекомендуют тест по моче
Всемирные руководства рекомендуют тест по моче
MEEHAN – 1997
CAP is the only acute respiratory tract infection in which delayed
antibiotic therapy has been associated with increased risk of death 1
HOUCK – 2004
15% reduction in mortality in the patients who received antibiotic
therapy within 4 hours of admission2
ZISS – 2003
Patients treated for CAP within 4 hours of arrival at hospital had a
significantly shorter inpatient length of stay, compared to patients who
received antibiotics more than 4 hours after arrival 3
1. Quality of Care, Process and Outcomes in Elderly Patients with Pneumonia - Meehan et al, JAMA 1997 278 (23) 2080-2084
2. Antibiotic administration in community-acquired pneumonia – Houck et al, Chest 2004 126 (1) 320-1
3. CAP: compliance with centers for Medicare and Medicaid services, national guidelines, and factors associated with outcomes – Ziss et al, SouthMedJ. 2003: 96 (10)
949-59
Targeted Treatment for CAP
Evaluating the Use of a Streptococcus pneumoniae Urinary Antigen Detection Kit for the Management of community acquired pneumonia in Japan -
Kobashi et al Respir 2007; 74 (4) 387-393
BinaxNOW S. pneumoniae : Supporting Evidence
Matta, 2009
541 patients, 233 patients with pneumonia
BinaxNOW 58/233 positive results
25% yield of pneumococcal pneumonia
Sputum/Blood culture 17 positives
8% yield of pneumococcal pneumonia
Do Clinicians Consider the Results of Binax NOW Streptococcus pneumoniae Urinary Antigen to Adapt Antibiotic Regimen in Pneumonia Patients?
Clinical Microbiology and Infection. Accepted Article 2009 Oct
BinaxNOW S. pneumoniae : Supporting Evidence
Sorde´ 2010
474 cases of CAP (S. pneumoniae 171, (36%)
Blood culture 53/171 (30.9%)
Sputum culture/Gram 38/171 (22.2%),
Pleural fluid 5/171 (2.9%)
BinaxNOW 130/153 (85%)
Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial
Therapy
BinaxNOW S. pneumoniae : Supporting Evidence
Weatherall 2008
Point-of-care urinary pneumococcal antigen test in the emergency department for community acquired pneumonia
Conclusion
(French Guidelines) Prise en charge des infections des voies respiratoires basses de l’adulte
immunocompétent
(European) Guidelines for the management of adult lower respiratory tract infections
All adult patients with severe CAP, should have blood culture, sputum
culture, Legionella UAT and S. pneumoniae UAT
KOOL – 1999
Introduction of the urinary antigen test led to recognition of
nosocomial cases2
Evidenced by the temporal relation between the introduction
of this test in San Antonio hospitals and
the rise in detected Legionellosis cases2
A recurrent Outbreak of Nosocomial Legionnaires’s Disease Detected by Urinary Antigen Testing: Evidence for Long term Colonization of a Hospital Plumbing System Lepine L et al. Infection
Control and Hospital Epidemiology December 1998 (12) 905-910
Hospital Characteristics Associated with Colonization of Water Systems by Legionella and Risk of Nosocomial Legionnaires’ Disease; A cohort study of 15 Hospitals, Kool J et al Infection Control
and Hospital Epidemiology December 1999 (20) 798-805
BinaxNOW Legionella Supporting Evidence
KANAVAKI – 2003
Laboratory Diagnosis of Legionnaires' Disease in Patients with Community Acquired Pneumonia (CAP)
BinaxNOW Legionella Supporting Evidence
ALVAREZ – 2010
Early detection and treatment reduced case fatality rate (CFR) by 68%
The UAT should be available in all hospitals and all cases of the
disease should be reported.
Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of
legionellosis in Catalonia, Spain, 1990—2004
Legionella Supporting Evidence
CAPNETZ 2010
All cases were sporadic
Community-Acquired Legionella Pneumonia: New Insights from the German Competence Network for Community Acquired Pneumonia
Legionella Supporting Evidence
Yu and Stout 2010
L. pneumophila shown to be one of the commonest causes of CAP
The ease of use of ICT card-type UAT makes it ideal for use in EDs,
long-term care facilities, and physician offices.
Rapid Diagnostic Testing for Community-Acquired Pneumonia Can Innovative Technology for Clinical Microbiology be exploited
Conclusion
Victor Yu 2011
A clinical Solution to Antimicrobial Resistance in Community-Acquired-Pneumonia Narrowing the Spectrum of Antimicrobial Therapy