Diagnosis and Medical Management

Diagnosis

A definitive diagnosis of infection with Streptococcus pneumoniae generally relies on isolation of the organism from blood or other normally sterile body sites. Tests are also available to detect capsular polysaccharide antigen in body fluids.

A urinary antigen test based on immunochromatographic membrane technique to detect the C-polysaccharide antigen of Streptococcus pneumoniae as a cause of community-acquired pneumonia among adults is commercially available. The test is rapid and simple to use, has a reasonable specificity in adults, and has the ability to detect pneumococcal pneumonia after antibiotic therapy has been started.

Medical Management

Available data [5.24 MB, 114 pages] demonstrate that in severe S. pneumoniae cases, the bacteria are fully resistant to one or more clinically relevant antibiotics.

Following the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, antibiotic resistance initially declined before increasing again. Then, in 2008, the Clinical and Laboratory Standards Institute (CLSI) changed the definition of penicillin resistance so that a much larger proportion of pneumococci are now considered susceptible to penicillin. The revised susceptibility breakpoints for Streptococcus pneumoniae were the result of a reevaluation that showed clinical response to penicillin was being preserved in clinical studies of pneumococcal infection, despite reduced susceptibility response in vitro.

For more information on medical management of pneumonia, please see the guidelines below.

Guidelines

Community-Acquired Pneumonia (CAP)

• IDSA and ATS Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults, 2007 [46 pages]
• PIDS and IDSA Clinical Practice Guidelines on the Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age, 2011 [52 pages]

Healthcare-Associated Pneumonia (HCAP)

• CDC and HICPAC Guidelines for Preventing Health-Care-Associated Pneumonia, 2003 [179 pages]
• IDSA and ATS Guidelines for the Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia, 2016 [51 pages]
• SHEA and IDSA Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update

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