一种用于疑似肺炎抗生素管理的多重聚合酶链反应检测方法。
A multiplex polymerase chain reaction assay for antibiotic stewardship in suspected pneumonia.
机构信息
Northwestern University Feinberg School of Medicine, Department of Medicine, Pulmonary and Critical Care Division, Chicago, IL.
Northwestern University Feinberg School of Medicine, Department of Medicine, Pulmonary and Critical Care Division, Chicago, IL.
出版信息
Diagn Microbiol Infect Dis. 2020 Dec;98(4):115179. doi: 10.1016/j.diagmicrobio.2020.115179. Epub 2020 Aug 16.
BACKGROUND
Multiplexed molecular rapid diagnostic tests (RDTs) may allow for rapid and accurate diagnosis of the microbial etiology of pneumonia. However, little data are available on multiplexed RDTs in pneumonia and their impact on clinical practice.
METHODS
This retrospective study analyzed 659 hospitalized patients for microbiological diagnosis of suspected pneumonia.
RESULTS
The overall sensitivity of the Unyvero LRT Panel was 85.7% (95% CI 82.3-88.7) and the overall specificity was 98.4% (95% CI 98.2-98.7) with a negative predictive value of 97.9% (95% CI 97.6-98.1). The LRT Panel result predicted no change in antibiotics in 12.4% of cases but antibiotic de-escalation in 65.9% (405/615) of patients, of whom 278/405 (69%) had unnecessary MRSA coverage and 259/405 (64%) had unnecessary P. aeruginosa coverage.
INTERPRETATION
In hospitalized adults with suspected pneumonia, use of an RDT on respiratory samples can allow for early adjustment of initial antibiotics, most commonly de-escalation.
背景
多重分子快速诊断检测（RDT）可实现对肺炎微生物病因的快速、准确诊断。然而，关于肺炎的多重 RDT 及其对临床实践的影响，数据有限。
方法
本回顾性研究分析了 659 例住院疑似肺炎患者的微生物学诊断。
结果
Unyvero LRT 检测试剂盒的总体敏感性为 85.7%（95%CI82.3-88.7），总体特异性为 98.4%（95%CI98.2-98.7），阴性预测值为 97.9%（95%CI97.6-98.1）。LRT 检测试剂盒的结果预测有 12.4%的病例无需改变抗生素，但 65.9%（405/615）的患者需要减少抗生素用量，其中 278/405（69%）不需要覆盖耐甲氧西林金黄色葡萄球菌（MRSA），259/405（64%）不需要覆盖铜绿假单胞菌。
结论
在住院的疑似肺炎成年人中，使用呼吸道样本的 RDT 可早期调整初始抗生素，最常见的是减少抗生素用量。
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