Diagnostic Value of ^99m Tc-Ubiquicidin Scintigraphy in Differentiating Bacterial from Nonbacterial Pneumonia

<b><i>Purpose:</i></b> Differentiating purely viral from bacterial etiologies continues to be a challenging yet key step in the management of community-acquired pneumonia (CAP), further highlighted since the COVID-19 pandemic. This study aims to evaluate the utility of ^99mTc-ubiquicidin (UBI) in the differentiation of bacterial from nonbacterial pneumonia. <b><i>Methods:</i></b> A total of 30 patients with CAP were allocated into groups A, bacterial (<i>n</i> = 15), and B, viral pneumonia (<i>n</i> = 15). All patients underwent ^99mTc-UBI scan with planar and single-photon emission computed tomography (SPECT) images of thorax acquired at 30 and 180 min postinjection. Target-to-background (T/B) ratios were calculated with values >1.4 interpreted as positive for bacterial infection. Correlation was made with computed tomography (CT) scan and polymerase chain reaction (PCR) results. <b><i>Results:</i></b> UBI scan was positive in 43.3% (<i>n</i> = 13) of patients, with sensitivity, specificity, and accuracy of 86.7%, 100%, and 93.3%, respectively, and close correlation with chest CT scan and PCR results (<i>p</i>-value = 0.000). Planar images were generally not helpful. Receiver operating characteristic curve analysis indicated similar diagnostic performance for 30-min and 3-h SPECT images by implementing T/B thresholds of 1.2 and 1.33, respectively. <b><i>Conclusions:</i></b> ^99mTc-UBI SPECT is a promising modality for differentiating purely viral from bacterial or superimposed bacterial pneumonia and provides reliable evidence either to mandate or withhold administration of antibiotics in patients with CAP.