Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia

March 31, 2016 at 8:05 am

Clinical Infectious Diseases April 1, 2016 V.62 N.7 P.817-823

Naomi J. Gadsby, Clark D. Russell, Martin P. McHugh, Harriet Mark, Andrew Conway Morris, Ian F. Laurenson, Adam T. Hill, and Kate E. Templeton

1Medical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh

2College of Medicine and Veterinary Medicine, University of Edinburgh

3Department of Anaesthesia, University of Cambridge

4Respiratory Medicine, Royal Infirmary of Edinburgh, United Kingdom

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.

PDF

http://cid.oxfordjournals.org/content/62/7/817.full.pdf

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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Biología Molecular, Epidemiología, F.O.D, Infecciones respiratorias, Infecciones virales, Influenza, Metodos diagnosticos, Sepsis, Update.

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