Utility of pneumococcal urinary antigen test (UAT) for antibiotic therapy or stewardship Retrospective single-centre study in 642 inpatients with pneumococcal UAT performed (period Aug 2011-March 2012) 38 patients (5.9%) were positive for pneumococcal UAT Indications (N=38): –58% with community-acquired pneumonia (N=22; CAP) –29% with healthcare-acquired pneumonia (N=11; HCAP) –13% other (N=5) –84% had an indication for pneumococcal UAT De-escalation of antibiotic therapy could have occurred in 9 patients –6 also had positive blood/sputum culture for Pneumococcus as basis for de-escalation, resulting in role for UAT in only 3 of 642 patients (0.5%) –1/3rd of CAP patients were de-escalated (N=7) Because UAT seems to have little effect on antibiotic therapy course and is expensive, the utility of pneumococcal UAT is questionnable Radigan E. IDSA 2012 abs.733

Aetiology of community-acquired pneumonia in hospitalised adults in the US CDC EPIC (Etiology of Pneumonia in the Community) study: prospective multi-centre design enrolling US patients with community-acquired pneumonia* Blood: culturing and lytA/spy Streptococcus PCR Sputum: culture and Legionella PCR Urine: Pneumococcus and Legionella antigen testing Naso/oropharyngeal swabs: PCR for respiratory viruses/atypical bacteria Preliminary data from Jan 2010-July 2011: 1,608 patients with community-acquired pneumonia –Admission to ICU / mortality: 21% / 3% –1st culture / PCR before inpatient antibiotics: 81% / 59% Jain S. IDSA 2012 abs of 2

Aetiology of community-acquired pneumonia in hospitalised adults in the US Viral or bacterial pathogen detected in 26% and 11% respectively Viruses seem more commonly detected than other pathogens in adults with community-acquired pneumonia Jain S. IDSA 2012 abs of 2