Chest
Original ResearchRespiratory InfectionsSystematic Review and Metaanalysis: Urinary Antigen Tests for Legionellosis
Section snippets
Search Strategy
We searched Medline from 1966 to August 2008 using Medical Subject Headings and a free-text search strategy, using the terms “urinary antigens”; “antigen, urine”; “antigens, bacterial”; “Legionellosis”; “Legionella”; and “Legionnaire.” In addition, we searched Excerpta Medica Database from 1968 to August 2008, using the search strategy (“Legionnaires disease” OR “Legionella” OR “Legionellosis”) AND (“urinary antigens” OR “bacterial antigens” OR Legionella urinary antigen“). Both searches were
Studies Identified
In the first stage, we identified 68 possibly relevant articles from the Medline search. Fifty full articles among these were selected for detailed analysis on the basis of title or abstract; 30 articles met the inclusion criteria. Retrieval and inclusion flow is shown in Figure 1, and the study characteristics of the 30 included studies15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44 are outlined in Table 1. Patient
Discussion
Our pooled analysis found that Legionella urinary antigen has very good specificity but low sensitivity for L pneumophila serogroup 1; thus, it is better for ruling in than ruling out disease. One of our most interesting findings is the 26% false-negative rate for Legionella urinary antigen. Practically speaking, this finding suggests that stopping therapy with anti-Legionella antibiotics in patients with a clinical suspicion for L pneumophila after a negative urinary antigen test result,
Acknowledgments
Author contributions: Drs. Shimada and Noguchi contributed to the conception and design of the study. Drs. Shimada, Jackson, and Miyashita contributed to acquisition, analysis, and interpretation of the data. Drs. Shimada, Noguchi, and Jackson drafted the article. Drs. Noguchi, Jackson, Hayashino, Kamiya, and Yamazaki critically revised the article for important intellectual content. Drs. Shimada, Jackson, and Fukuhara contributed to the final approval of the article. Dr. Jackson provided
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
Funding/Support: This study was supported by a grant (No. H18-001) from the Ministry of Health, Labor and Welfare in Japan, “Development of Clinical Research Fellowship” (Principal Investigator, Shunichi Fukuhara)