Dhesi Zaneeta, Enne Virve I, O'Grady Justin, Gant Vanya, Livermore David M
University College London, Gower Street, London WC1E 6BT, United Kingdom.
Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UA, United Kingdom.
ACS Pharmacol Transl Sci. 2020 May 12;3(3):401-417. doi: 10.1021/acsptsci.0c00027. eCollection 2020 Jun 12.
This is a narrative review on the potential of rapid and point-of-care microbiological testing in pneumonia patients, focusing particularly on hospital-acquired and ventilator-associated pneumonia, which have substantial mortality and diverse microbiology. This work is written from a United Kingdom perspective, but much of it is generalizable internationally. In a world where antimicrobial resistance is a major international threat, the use of rapid molecular diagnostics has great potential to improve both the management of pneumonia patients and the stewardship of antibiotics. Rapid tests potentially can distinguish patients with bacterial versus viral infection and can swiftly identify bacterial pathogens and their resistances. We seek to answer the question: "Can such tests be used as an antibiotic guardian?" Their availability at the bedside rather than in the laboratory should best ensure that results are swiftly used to optimize patient management but will raise new challenges, not the least with respect to maintaining quality control and microbiology/infection control input. A further challenge lies in assessing the degree of trust that treating clinicians will place in these molecular diagnostic tests, particularly when early de-escalation of antibiotic therapy is indicated.
这是一篇关于快速即时检测微生物学技术在肺炎患者中应用潜力的叙述性综述，特别关注医院获得性肺炎和呼吸机相关性肺炎，这两种肺炎具有较高的死亡率且微生物学特征多样。本文从英国的视角撰写，但其中大部分内容在国际上具有通用性。在抗菌药物耐药性成为重大国际威胁的背景下，快速分子诊断技术在改善肺炎患者的治疗及抗生素管理方面具有巨大潜力。快速检测有可能区分细菌感染与病毒感染的患者，并能迅速识别细菌病原体及其耐药性。我们试图回答以下问题：“此类检测能否作为抗生素的守护者？”检测在床边而非实验室进行，应能最好地确保检测结果迅速用于优化患者管理，但这也将带来新的挑战，尤其是在维持质量控制以及微生物学/感染控制方面。另一个挑战在于评估治疗临床医生对这些分子诊断检测的信任程度，特别是在需要早期降阶梯使用抗生素治疗时。
