The clinical impact of the detection of potential etiologic pathogens of community-acquired pneumonia

Abstract

The etiology of community-acquired pneumonia (CAP) is determined in less than half of the patients based on cultures of sputum and blood plus testing urine for the antigens of Streptococcus pneumoniae and Legionella pneumophila. This study added nasal polymerase chain reaction (PCR) probes for S. pneumoniae, Staphylococcus aureus, and respiratory viruses. Serum procalcitonin (PCT) levels were measured. Pathogens were identified in 78% of the patients. For detection of viruses, patients were randomized to either a 5-virus laboratory-generated PCR bundle or the 17-virus FilmArray PCR platform. The FilmArray PCR platform detected more viruses than the laboratory-generated bundle and did so in less than 2 hours. There were fewer days of antibiotic therapy, P = 0.003, in CAP patients with viral infections and a low serum PCT levels.

The potential of molecular diagnostics and serum procalcitonin levels to change the antibiotic management of community-acquired pneumonia

“…The absence of an elevated PCT level in a patient with a clinical syndrome compatible with a viral illness strongly suggests the absence of an active bacterial infection, and no benefit to empiric antibiotic therapy (Becker et al, 2008;Branche et al, 2015;Falsey et al, 2013;Gelfer et al, 2015;Gilbert, 2011Gilbert, , 2015Schuetz et al, 2012Schuetz et al, , 2013.…”

“…The protocol described herein is the same used during January to March, 2014 (Gelfer et al, 2015), enrolling an additional 127 patients during the 2014-2015 winter months.…”

Performance evaluation of direct fluorescent antibody, Focus Diagnostics Simplexa™ Flu A/B & RSV and multi-parameter customized respiratory Taqman® array card in immunocompromised patients

“…Even though targeted antiviral treatment not always exists, other treatment options such as antifungals or corticosteroids could be important. In addition, the diagnosis of a viral respiratory infection can potentially reduce the use of antibiotics (Gelfer et al, 2015;Falsey et al, 2013;Rogers et al, 2015), it can assist infection control practitioners in providing appropriate infection control measures (e.g. droplet and/or contact precautions and considerations in creating cohorts) and it can stop the more thorough search for a diagnosis avoiding unnecessary medical procedures.…”

Other Community Respiratory Viruses

“…The combination of a low procalcitonin and positive RVP is also demonstrated to be too few antibiotics in an observational study of pneumonia. 14 Until true randomized control trials are available, the current data suggest that a positive RVP alone is insufficient evidence to discontinue antibiotics. However, a positive RVP seems to have a synergistic effect with procalcitonin, a biomarker that has independently been associated with decreased antibiotic therapy, to decrease the duration of antibiotic therapy.…”