Streptococcus Pneumoniae Urinary Antigen Test and Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Figures & data

Table 1.  Demographic details and outcomes of all 82 subjects first hospitalized with acute exacerbations of chronic obstructive pulmonary disease and a comparison between subjects positive and negative for pneumococcal urinary antigen

		All subjects first hospitalized with AECOPD					Urinary Pneumococcal Antigen
							Negative					Positive
		N	Mean ± SD or	N(%)		N	Mean ± SD or	N(%)		N	Mean ± SD or	N(%)		P- value
Age	(years)	82	74.4 ±8.8				68	74.2 ±7.9				14	75.5 ±12.7		0.62
Gender	(male)	82	69 (84.1%)		68	58 (85.3%)		14	11 (78.6%)		0.69
History of smoking	(pack-years)	82	77 ±39				68	79 ±39				14	68 ±37		0.33
Body mass index	(kg/m2)	76	20.2 ±3.1				63	20.4 ±3.1				13	19.7 ±3.3		0.47
Pneumonia as a complication	(present)	82	34 (41.5%)		68	27 (39.7%)		14	7 (50.0%)		0.56
Ambulance transportation	(yes)	82	30 (36.6%)		68	25 (36.8%)		14	5 (35.7%)		0.99
Arterial blood gases at the beginning of treatment
	PaO2	(mmHg)	82	61.9 ±22.1				68	61.8 ± 23.8				14	62.4 ± 10.8		0.93
	PaCO2	(mmHg)	82	44.4± 15.5				68	45.6 ± 16.2				14	38.1 ± 9.9		0.10
	pH		82	7.409 ±0.071				68	7.406 ± 0.071				14	7.429 ± 0.067		0.27
Pulmonary function tests after treatment
	FVC	(L)	76	2.40 ± 0.80				63	2.44 ± 0.75				13	2.19 ± 1.00		0.30
	FVC	(%predicted)	76	80.5 ± 22.4				63	81.8 ± 21.5				13	74.5 ± 26.3		0.29
	FEV1	(L)	76	1.10 ± 0.52				63	1.10 ± 0.51				13	1.11 ± 0.62		0.98
	FEV1	(%predicted)	76	56.5 ± 25.1				63	56.0 ± 24.7				13	59.2 ± 27.5		0.68
	FEV1 /FVC	(%)	76	45.9 ±14.5				63	44.9 ± 14.4				13	50.9 ± 14.0		0.18
Length of stay	(days)	82	19.4 ± 17.9				68	20.1 ± 19.4				14	15.6 ± 4.5		0.40
Re-admission within 30 days	Number (%)	77	10 (13.0%)		63	9 (14.3%)		14	1 (7.1%)		0.68
Mortality during hospitalization	Number (%)	82	3 (3.7%)		68	3 (4.4%)		14	0 (0%)		0.99
Mortality within 30 days	Number (%)	81	4 (4.9%)		67	3 (4.5%)		14	1 (7.1%)		0.54
Mortality within 90 days	Number (%)	77	7 (9.1%)		64	4 (6.3%)		13	3 (23.1%)		0.09

Table 2.  Comparison of the results from the urinary antigen test and sputum culture and the distribution of positive results by COPD severity

Urinary antigen positive			Urinary antigen negative
Streptococcus pneumoniae from sputum culture			sputum not available		Streptococcus pneumoniae from sputum culture		sputum not available	Total
		positive	negative		positive	negative
All episodes (N = 122)	GOLD stage I	1	1	0	0	13	2	17
	GOLD stage II	3	2	2	1	32	1	41
	GOLD stage III	1	4	0	0	38	2	45
	GOLD stage IV	1	1	0	0	14	3	19
	Total	6	8	2	1	97	8	122
All patients (N = 82)	GOLD stage I	1	1	0	0	12	2	16
	GOLD stage II	3	2	1	1	18	0	25
	GOLD stage III	1	3	0	0	25	2	31
	GOLD stage IV	1	1	0	0	7	1	10
	Total	6	7	1	1	62	5	82
Non-pneumonic exacerbation (N = 48)	GOLD stage I	0	0	0	0	6	2	8
	GOLD stage II	1	1	1	0	8	0	11
	GOLD stage III	0	2	0	0	18	2	22
	GOLD stage IV	1	1	0	0	4	1	7
	Total	2	4	1	0	36	5	48
Pneumonic exacerbation (N = 34)	GOLD stage I	1	1	0	0	6	0	8
	GOLD stage II	2	1	0	1	10	0	14
	GOLD stage III	1	1	0	0	7	0	9
	GOLD stage IV	0	0	0	0	3	0	3
	Total	4	3	0	1	26	0	34

Table 3.  Results of a sputum culture in all 122 episodes hospitalized with acute exacerbations of chronic obstructive pulmonary disease

Number (Percentage) of Bacterial Isolates	Pathogen
7 (5.7%)	Streptococcus pneumoniae
	(including 4 episodes with PISP and one with PRSP)
6 (4.9%)	Klebsiella pneumoniae
5 (4.1%)	Staphylococcus aureus
	(including 3 episodes with MRSA)
5 (4.1%)	Haemophilus influenza
3 (2.5%)	Serratia marcescens
3 (2.5%)	Moraxella catarrhalis
2 (1.6%)	Stenotrophomonas maltophilia
2 (1.6%)	Escherichia coli
2 (1.6%)	Enterobacter cloacae
1 (0.8%)	Proteus mirabilis
1 (0.8%)	Pseudomonas aeruginosa
1 (0.8%)	Enterobacter aerogenes
1 (0.8%)	Morganella morganii
1 (0.8%)	Chryseobacterium indologenes
1 (0.8%)	Citrobacter freundii
1 (0.8%)	Klebsiella oxytoca

(Multiple pathogens were isolated in six episodes.)

1) PISP: penicillin-intermediate Streptococcus pneumoniae; 2) PRSP: penicillin-resistant Streptococcus pneumoniae; 3) MRSA: methicillin-resistant Staphylococcus aureus.

Table 4.  Comparison of the results of the urinary antigen test and sputum culture in all 607 evaluations with stable chronic obstructive pulmonary disease

Stable COPD		Streptococcus pneumoniae from sputum culture		sputum not available	Total
		positive	negative
Urinary antigen	Positive	4	10	2	16
	Negative	19	356	216	591
Total		23	366	218	607