Intensive Care Medicine

, Volume 32, Issue 11, pp 1766–1772 | Cite as

Evaluation of the Binax NOW Streptococcus pneumoniae urinary antigen assay in intensive care patients hospitalized for pneumonia

  • Sigismond Lasocki
  • Agnès Scanvic
  • Françoise Le Turdu
  • Aymeric Restoux
  • Hervé Mentec
  • Gérard Bleichner
  • Jean-Pierre Sollet



To evaluate the diagnostic performance of Binax Now S. pneumoniae urinary antigen rapid immunochromatographic membrane test (ICT) for patients with suspicion of community-acquired pneumonia hospitalized in intensive care and to assess the impact of prior antibiotics on its diagnostic performance.

Design and setting

Retrospective study in a medicosurgical ICU in a 700-bed general hospital.


Charts of patients with ICT performed (result blinded) were reviewed between May 2002 and July 2004. ICT has been performed in 140 of the 1,006 patients hospitalized in the unit; two-thirds had received antibiotics prior to admission.

Measurements and results

Diagnosis of pneumonia was made according to usual criteria. All patients had at least one microbiological test. Pneumonia diagnosis confirmed in 108 patients including 32 pneumococcal. ICT was positive in 23 of 32 patients with pneumococcal pneumonia, in 11 of 108 without, and in none of the 32 patients without pneumonia, resulting in sensitivity, specificity, and positive and negative predictive values of, respectively: 72%, 90%, 68% and 92%. Positive likelihood ratios were comparable among patients with or without prior antibiotics (respectively 6 and 12 for 7 in the overall population).


This first clinical evaluation of ICT in intensive care patients hospitalized for suspicion of community-acquired pneumonia, demonstrated performance in accordance with published data even in the case of prior antibiotics. Its clinical interest and impact on antibiotics policy remain to be refined.


Pneumonia Sensitivity and specificity Streptococcus pneumoniae Streptococcus pneumoniae urinary antigen test 


  1. 1.
    Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, Kapoor WN (1996) Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA 275:134–141PubMedCrossRefGoogle Scholar
  2. 2.
    Moine P, Vercken JB, Chevret S, Chastang C, Gajdos P (1994) Severe community-acquired pneumonia. Etiology, epidemiology, and prognosis factors. French Study Group for Community-Acquired Pneumonia in the Intensive Care Unit. Chest 105:1487–1495PubMedGoogle Scholar
  3. 3.
    Leroy O, Santre C, Beuscart C, Georges H, Guery B, Jacquier JM, Beaucaire G (1995) A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit. Intensive Care Med 21:24–31PubMedCrossRefGoogle Scholar
  4. 4.
    Bartlett JG (2004) Diagnostic test for etiologic agents of community-acquired pneumonia. Infect Dis Clin North Am 18:809–827PubMedCrossRefGoogle Scholar
  5. 5.
    Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C (2003) Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 37:1405–1433PubMedCrossRefGoogle Scholar
  6. 6.
    Olaechea PM, Quintana JM, Gallardo MS, Insausti J, Maravi E, Alvarez B (1996) A predictive model for the treatment approach to community-acquired pneumonia in patients needing ICU admission. Intensive Care Med 22:1294–1300PubMedGoogle Scholar
  7. 7.
    Ruiz-Gonzalez A, Falguera M, Vives M, Nogues A, Porcel JM, Rubio-Caballero M (2000) Community-acquired pneumonia: development of a bedside predictive model and scoring system to identify the aetiology. Respir Med 94:505–510PubMedCrossRefGoogle Scholar
  8. 8.
    Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C (2003) Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 31:2742–2751PubMedCrossRefGoogle Scholar
  9. 9.
    Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474PubMedCrossRefGoogle Scholar
  10. 10.
    Ruiz M, Ewig S, Torres A, Arancibia F, Marco F, Mensa J, Sanchez M, Martinez JA (1999) Severe community-acquired pneumonia. Risk factors and follow-up epidemiology. Am J Respir Crit Care Med 160:923–929PubMedGoogle Scholar
  11. 11.
    Roson B, Carratala J, Verdaguer R, Dorca J, Manresa F, Gudiol F (2000) Prospective study of the usefulness of sputum Gram stain in the initial approach to community-acquired pneumonia requiring hospitalization. Clin Infect Dis 31:869–874PubMedCrossRefGoogle Scholar
  12. 12.
    Ruiz-Gonzalez A, Falguera M, Nogues A, Rubio-Caballero M (1999) Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia. Am J Med 106:385–390PubMedCrossRefGoogle Scholar
  13. 13.
    Gutierrez F, Masia M, Rodriguez JC, Ayelo A, Soldan B, Cebrian L, Mirete C, Royo G, Hidalgo AM (2003) Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin Infect Dis 36:286–292PubMedCrossRefGoogle Scholar
  14. 14.
    Murdoch DR, Laing RT, Mills GD, Karalus NC, Town GI, Mirrett S, Reller LB (2001) Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol 39:3495–3498PubMedCrossRefGoogle Scholar
  15. 15.
    Andreo F, Dominguez J, Ruiz J, Blanco S, Arellano E, Prat C, Morera J, Ausina V (2006) Impact of rapid urine antigen tests to determine the etiology of community-acquired pneumonia in adults. Respir Med 100:884–891PubMedCrossRefGoogle Scholar
  16. 16.
    Stralin K, Kaltoft MS, Konradsen HB, Olcen P, Holmberg H (2004) Comparison of two urinary antigen tests for establishment of pneumococcal etiology of adult community-acquired pneumonia. J Clin Microbiol 42:3620–3625PubMedCrossRefGoogle Scholar
  17. 17.
    Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Ann Intern Med 138:40–44PubMedGoogle Scholar
  18. 18.
    Grimes DA, Schulz KF (2005) Refining clinical diagnosis with likelihood ratios. Lancet 365:1500–1505PubMedCrossRefGoogle Scholar
  19. 19.
    Smith MD, Derrington P, Evans R, Creek M, Morris R, Dance DA, Cartwright K (2003) Rapid diagnosis of bacteremic pneumococcal infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective, controlled clinical evaluation. J Clin Microbiol 41:2810–2813PubMedCrossRefGoogle Scholar
  20. 20.
    Butler JC, Bosshardt SC, Phelan M, Moroney SM, Tondella ML, Farley MM, Schuchat A, Fields BS (2003) Classical and latent class analysis evaluation of sputum polymerase chain reaction and urine antigen testing for diagnosis of pneumococcal pneumonia in adults. J Infect Dis 187:1416–1423PubMedCrossRefGoogle Scholar
  21. 21.
    Roson B, Fernandez-Sabe N, Carratala J, Verdaguer R, Dorca J, Manresa F, Gudiol F (2004) Contribution of a urinary antigen assay (Binax NOW) to the early diagnosis of pneumococcal pneumonia. Clin Infect Dis 38:222–226PubMedCrossRefGoogle Scholar
  22. 22.
    Sorensen UB, Henrichsen J (1987) Cross-reactions between pneumococci and other streptococci due to C polysaccharide and F antigen. J Clin Microbiol 25:1854–1859PubMedGoogle Scholar
  23. 23.
    Sjogren AM, Holmberg H, Krook A (1987) Etiologic diagnosis of pneumonia by antigen detection: crossreactions between pneumococcal C-polysaccharide and oral microorganisms. Diagn Microbiol Infect Dis 6:239–248PubMedCrossRefGoogle Scholar
  24. 24.
    Marcos MA, Jimenez de Anta MT, de la Bellacasa JP, Gonzalez J, Martinez E, Garcia E, Mensa J, de Roux A, Torres A (2003) Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults. Eur Respir J 21:209–214PubMedCrossRefGoogle Scholar
  25. 25.
    Murdoch DR, Laing RT, Cook JM (2003) The NOW S. pneumoniae urinary antigen test positivity rate 6 weeks after pneumonia onset and among patients with COPD. Clin Infect Dis 37:153–154PubMedCrossRefGoogle Scholar
  26. 26.
    Hamer DH, Egas J, Estrella B, MacLeod WB, Griffiths JK, Sempertegui F (2002) Assessment of the Binax NOW Streptococcus pneumoniae urinary antigen test in children with nasopharyngeal pneumococcal carriage. Clin Infect Dis 34:1025–1028PubMedCrossRefGoogle Scholar
  27. 27.
    Regev-Yochay G, Raz M, Dagan R, Porat N, Shainberg B, Pinco E, Keller N, Rubinstein E (2004) Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. Clin Infect Dis 38:632–639PubMedCrossRefGoogle Scholar
  28. 28.
    Mellencamp MA, Preheim LC, McDonald TL (1987) Isolation and characterization of circulating immune complexes from patients with pneumococcal pneumonia. Infect Immun 55:1737–1742PubMedGoogle Scholar
  29. 29.
    Stralin K, Holmberg H (2005) Usefulness of the Streptococcus pneumoniae urinary antigen test in the treatment of community-acquired pneumonia. Clin Infect Dis 41:1209–1210PubMedCrossRefGoogle Scholar
  30. 30.
    Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Sigismond Lasocki
    • 1
  • Agnès Scanvic
    • 2
  • Françoise Le Turdu
    • 2
  • Aymeric Restoux
    • 3
  • Hervé Mentec
    • 3
  • Gérard Bleichner
    • 3
  • Jean-Pierre Sollet
    • 3
  1. 1.Service de Réanimation ChirurgicaleCHU Bichat-Claude BernardParis Cedex 18France
  2. 2.Service de BiologieCH Victor DupouyArgenteuilFrance
  3. 3.Service de Réanimation polyvalenteCH Victor DupouyArgenteuilFrance

Personalised recommendations