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. 2021 Jul 31;11(8):762.
doi: 10.3390/jpm11080762.

Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE)

Pietro Valsecchi  1 , Marta Colaneri  1 , Valentina Zuccaro  1 , Erika Asperges  1 , Filippo Costanzo  2 , Bianca Mariani  3 , Silvia Roda  1 , Rita Minucci  4 , Francesco Bertuccio  5 , Elia Fraolini  5 , Matteo Bosio  5 , Claudio Tirelli  5 , Tiberio Oggionni  5 , Angelo Corsico  5   6 , Raffaele Bruno  1   6
Affiliations

Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE)

Pietro Valsecchi et al. J Pers Med. .

Abstract

Despite low rates of bacterial co-infections, most COVID-19 patients receive antibiotic therapy. We hypothesized that patients with positive pneumococcal urinary antigens (PUAs) would benefit from antibiotic therapy in terms of clinical outcomes (death, ICU admission, and length of stay). The San Matteo COVID-19 Registry (SMACORE) prospectively enrolls patients admitted for COVID-19 pneumonia at IRCCS Policlinico San Matteo, Pavia. We retrospectively extracted the data of patients tested for PUA from October to December 2020. Demographic, clinical, and laboratory data were recorded. Of 469 patients, 42 tested positive for PUA (8.95%), while 427 (91.05%) tested negative. A positive PUA result had no significant impact on death (HR 0.53 CI [0.22-1.28] p-value 0.16) or ICU admission (HR 0.8; CI [0.25-2.54] p-value 0.70) in the Cox regression model, nor on length of stay in linear regression (estimate 1.71; SE 2.37; p-value 0.47). After adjusting for age, we found no significant correlation between urinary antigen positivity and variations in the WHO ordinal scale and laboratory markers at admission and after 14 days. We found that a positive PUA result was not frequent and had no impact on clinical outcomes or clinical improvement. Our results did not support the routine use of PUA tests to select COVID-19 patients who will benefit from antibiotic therapy.

Keywords: COVID-19; SARS-CoV-2; Streptococcus pneumoniae; antibiotic therapy; pneumococcal urinary antigen.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Survival curves. (A) Survival curve for death. (B) Survival curve for ICU admission. Note: PUA = pneumococcal urinary antigen.
Figure 2
Figure 2
Box and whiskers charts. (A) Variation in WHO ordinal scale at 7 and 14 days from baseline. (B) Variations in CRP levels at 7 days from baseline; (C) variations in the neutrophil count at 7 days from baseline; (D) variation of the lymphocyte count at 7 days from baseline. Abbreviations CRP C-reactive protein, PUA pneumococcal urinary antigen.
See this image and copyright information in PMC

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