Clinical impact of bacterial syndromic testing in pneumonia

A cornerstone in the management of patients with pneumonia is timely and appropriate antibiotic therapy, which requires early and accurate pathogen detection. 1 Liu VX Fielding-Singh V Greene JD et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med. 2017; 196: 856-863 Crossref PubMed Scopus (327) Google Scholar Pathogen identification is currently limited by the poor sensitivity and long turnaround time of standard culture-based diagnostic tools. 2 MacVane SH Oppermann N Humphries RM Time to result for pathogen identification and antimicrobial susceptibility testing of bronchoalveolar lavage and endotracheal aspirate specimens in U.S. acute care hospitals. J Clin Microbiol. 2020; 58: e01468-e01520 Crossref PubMed Scopus (1) Google Scholar Empirical antibiotics are often initiated while clinicians await results of respiratory culture. If inadequate empirical antibiotics are selected, the risk of adverse outcomes is increased, highlighting a need for better diagnostic tools to optimise antibiotic prescribing. 3 Rhee C Kadri SS Dekker JP et al. Prevalence of antibiotic-resistant pathogens in culture-proven sepsis and outcomes associated with inadequate and broad-spectrum empiric antibiotic use. JAMA Netw Open. 2020; 3e202899 Crossref Scopus (64) Google Scholar Over the past decade, rapid culture-independent methods of pathogen detection emerged as a potential way to improve diagnosis and ideally limit inappropriate antibiotic use. However, to date, no randomised controlled trial has assessed the impact of multiplex PCR results on inappropriate antibiotics in patients with pneumonia and risk factors for Gram-negative bacterial infection. Fast multiplex bacterial PCR of bronchoalveolar lavage for antibiotic stewardship in hospitalised patients with pneumonia at risk of Gram-negative bacterial infection (Flagship II): a multicentre, randomised controlled trialMultiplex bacterial PCR examination of bronchoalveolar lavage decreases the duration of inappropriate antibiotic therapy of patients admitted to hospital with pneumonia and at risk of Gram-negative rod infection. This approach warrants further consideration in future antibiotic stewardship strategies. Full-Text PDF