Diagnosis and Medical Management
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.
Available data show that pneumococcal bacteria are resistant to one or more antibiotics in 30% of cases.
Available data pdf icon[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.
Community-Acquired Pneumonia (CAP)
- Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of ATS and IDSA, 2019external icon
- PIDS and IDSA Clinical Practice Guidelines on the Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age, 2011 pdf icon[52 pages]external icon
Healthcare-Associated Pneumonia (HCAP)
- CDC and HICPAC Guidelines for Preventing Health-Care-Associated Pneumonia, 2003 pdf icon[179 pages]
- IDSA and ATS Guidelines for the Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia, 2016 pdf icon[51 pages]external icon
- SHEA and IDSA Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Updateexternal icon