Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia. - PubMed - NCBI

Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia. - PubMed - NCBI

Clin Infect Dis. 2016 Jan 7. pii: civ1214. [Epub ahead of print]

Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia.

Gadsby NJ1, Russell CD2, McHugh MP1, Mark H1, Conway Morris A3, Laurenson IF1, Hill AT4, Templeton KE1.

Author information

Abstract

BACKGROUND:

 The frequent lack of a microbiological diagnosis in community-acquired pneumonia (CAP) impairs pathogen-directed antimicrobial therapy. This study assessed the use of comprehensive multibacterial, multiviral molecular testing, including quantification, in adults hospitalized with CAP.

METHODS:

 Clinical and laboratory data were collected for 323 adults with radiologically-confirmed CAP admitted to 2 UK tertiary care hospitals. Sputum (96%) or endotracheal aspirate (4%) specimens were cultured as per routine practice and also tested with fast multiplex real-time polymerase-chain reaction (PCR) assays for 26 respiratory bacteria and viruses. Bacterial loads were also calculated for 8 bacterial pathogens. Appropriate pathogen-directed therapy was retrospectively assessed using national guidelines adapted for local antimicrobial susceptibility patterns.

RESULTS:

 Comprehensive molecular testing of single lower respiratory tract (LRT) specimens achieved pathogen detection in 87% of CAP patients compared with 39% with culture-based methods. Haemophilus influenzae and Streptococcus pneumoniae were the main agents detected, along with a wide variety of typical and atypical pathogens. Viruses were present in 30% of cases; 82% of these were codetections with bacteria. Most (85%) patients had received antimicrobials in the 72 hours before admission. Of these, 78% had a bacterial pathogen detected by PCR but only 32% were culture-positive (P < .0001). Molecular testing had the potential to enable de-escalation in number and/or spectrum of antimicrobials in 77% of patients.

CONCLUSIONS:

 Comprehensive molecular testing significantly improves pathogen detection in CAP, particularly in antimicrobial-exposed patients, and requires only a single LRT specimen. It also has the potential to enable early de-escalation from broad-spectrum empirical antimicrobials to pathogen-directed therapy.

© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

KEYWORDS:

PCR; bacterial load; community-acquired pneumonia; molecular testing; viral

PMID:

 

26747825

 

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