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  • Effectiveness of Streptococcus Pneumoniae Urinary Antigen Testing in Decreasing Mortality of COVID-19 Co-Infected Patients: A Clinical Investigation #MMPMID33138045
  • Desai A; Santonocito OG; Caltagirone G; Kogan M; Ghetti F; Donadoni I; Porro F; Savevski V; Poretti D; Ciccarelli M; Martinelli Boneschi F; Voza A
  • Medicina (Kaunas) 2020[Oct]; 56 (11): ä PMID33138045show ga
  • BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae urinary antigen (u-Ag) testing has recently gained attention in the early diagnosis of severe and critical acute respiratory syndrome coronavirus-2/pneumococcal co-infection. The aim of this study is to assess the effectiveness of Streptococcus pneumoniae u-Ag testing in coronavirus disease 2019 (COVID-19) patients, in order to assess whether pneumococcal co-infection is associated with different mortality rate and hospital stay in these patients. MATERIALS AND METHODS: Charts, protocols, mortality, and hospitalization data of a consecutive series of COVID-19 patients admitted to a tertiary hospital in northern Italy during COVID-19 outbreak were retrospectively reviewed. All patients underwent Streptococcus pneumoniae u-Ag testing to detect an underlying pneumococcal co-infection. Covid19+/u-Ag+ and Covid19+/u-Ag- patients were compared in terms of overall survival and length of hospital stay using chi-square test and survival analysis. RESULTS: Out of 575 patients with documented pneumonia, 13% screened positive for the u-Ag test. All u-Ag+ patients underwent treatment with Ceftriaxone and Azithromycin or Levofloxacin. Lopinavir/Ritonavir or Darunavir/Cobicistat were added in 44 patients, and hydroxychloroquine and low-molecular-weight heparin (LMWH) in 47 and 33 patients, respectively. All u-Ag+ patients were hospitalized. Mortality was 15.4% and 25.9% in u-Ag+ and u-Ag- patients, respectively (p = 0.09). Survival analysis showed a better prognosis, albeit not significant, in u-Ag+ patients. Median hospital stay did not differ among groups (10 vs. 9 days, p = 0.71). CONCLUSIONS: The routine use of Streptococcus pneumoniae u-Ag testing helped to better target antibiotic therapy with a final trend of reduction in mortality of u-Ag+ COVID-19 patients having a concomitant pneumococcal infection. Randomized trials on larger cohorts are necessary in order to draw definitive conclusion.
  • |*Hospital Mortality[MESH]
  • |Adult[MESH]
  • |Aged[MESH]
  • |Aged, 80 and over[MESH]
  • |Anti-Bacterial Agents/*therapeutic use[MESH]
  • |Anticoagulants/therapeutic use[MESH]
  • |Antigens, Bacterial/urine[MESH]
  • |Antiviral Agents/*therapeutic use[MESH]
  • |Azithromycin/therapeutic use[MESH]
  • |Betacoronavirus[MESH]
  • |COVID-19[MESH]
  • |Ceftriaxone/therapeutic use[MESH]
  • |Cobicistat/therapeutic use[MESH]
  • |Coinfection/*diagnosis/urine[MESH]
  • |Coronavirus Infections/complications/*drug therapy[MESH]
  • |Cross-Sectional Studies[MESH]
  • |Darunavir/therapeutic use[MESH]
  • |Drug Combinations[MESH]
  • |Female[MESH]
  • |Heparin, Low-Molecular-Weight/therapeutic use[MESH]
  • |Humans[MESH]
  • |Hydroxychloroquine/therapeutic use[MESH]
  • |Length of Stay/statistics & numerical data[MESH]
  • |Levofloxacin/therapeutic use[MESH]
  • |Lopinavir/therapeutic use[MESH]
  • |Male[MESH]
  • |Mass Screening[MESH]
  • |Middle Aged[MESH]
  • |Pandemics[MESH]
  • |Pneumonia, Pneumococcal/complications/diagnosis/*drug therapy/urine[MESH]
  • |Pneumonia, Viral/complications/*drug therapy[MESH]
  • |Retrospective Studies[MESH]
  • |Ritonavir/therapeutic use[MESH]
  • |SARS-CoV-2[MESH]
  • |Streptococcus pneumoniae/immunology[MESH]

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  • suck abstract from ncbi

    ä 11.56 2020