Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy.
Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; Department of Internal Medicine, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.
Clin Microbiol Infect. 2022 Jan;28(1):13-22. doi: 10.1016/j.cmi.2021.09.025. Epub 2021 Oct 1.
Point-of-care tests could be essential in differentiating bacterial and viral acute community-acquired lower respiratory tract infections and driving antibiotic stewardship in the community.
To assess diagnostic test accuracy of point-of-care tests in community settings for acute community-acquired lower respiratory tract infections.
Multiple databases (MEDLINE, EMBASE, Web of Science, Cochrane Library, Open Gray) from inception to 31 May 2021, without language restrictions.
Diagnostic test accuracy studies involving patients at primary care, outpatient clinic, emergency department and long-term care facilities with a clinical suspicion of acute community-acquired lower respiratory tract infections. The comparator was any test used as a comparison to the index test. In order not to limit the study inclusion, the comparator was not defined a priori.
Four investigators independently extracted data, rated risk of bias, and assessed the quality using QUADAS-2.
The measures of diagnostic test accuracy were calculated with 95% CI.
A total of 421 studies addressed at least one point-of-care test. The diagnostic performance of molecular tests was higher compared with that of rapid diagnostic tests for all the pathogens studied. The accuracy of stand-alone signs and symptoms or biomarkers was poor. Lung ultrasound showed high sensitivity and specificity (90% for both) for the diagnosis of bacterial pneumonia. Rapid antigen-based diagnostic tests for influenza, respiratory syncytial virus, human metapneumovirus, and Streptococcus pneumoniae had sub-optimal sensitivity (range 49%-84%) but high specificity (>80%).
Physical examination and host biomarkers are not sufficiently reliable as stand-alone tests to differentiate between bacterial and viral pneumonia. Lung ultrasound shows higher accuracy than chest X-ray for bacterial pneumonia at emergency department. Rapid antigen-based diagnostic tests cannot be considered fully reliable because of high false-negative rates. Overall, molecular tests for all the pathogens considered were found to be the most accurate.
即时检测（point-of-care test，POCT）对于区分细菌性和病毒性急性社区获得性下呼吸道感染并在社区中推动抗生素管理可能至关重要。
评估社区环境中 POCT 对急性社区获得性下呼吸道感染的诊断测试准确性。
从创建到 2021 年 5 月 31 日，在多个数据库（MEDLINE、EMBASE、Web of Science、Cochrane 图书馆、Open Gray）中进行了无语言限制的检索。
涉及初级保健、门诊、急诊和长期护理机构中具有急性社区获得性下呼吸道感染临床疑似症状的患者的诊断测试准确性研究。比较器是任何与参考测试进行比较的测试。为了不限制研究纳入，比较器未事先定义。
四位研究者独立提取数据，评估风险偏倚，并使用 QUADAS-2 评估质量。
使用 95%CI 计算诊断测试准确性的测量值。
共有 421 项研究至少涉及一种 POCT。与快速诊断检测相比，所有研究病原体的分子检测的诊断性能更高。孤立的体征和症状或生物标志物的准确性较差。肺部超声对细菌性肺炎的诊断具有高敏感性和特异性（均为 90%）。针对流感、呼吸道合胞病毒、人偏肺病毒和肺炎链球菌的快速抗原基诊断测试的敏感性（范围为 49%-84%）较低，但特异性（>80%）较高。
体格检查和宿主生物标志物作为单独的测试不足以可靠地区分细菌性和病毒性肺炎。在急诊室，肺部超声对细菌性肺炎的准确性高于胸部 X 光。由于高假阴性率，快速抗原基诊断测试不能被认为是完全可靠的。总体而言，考虑到所有病原体的分子检测被发现是最准确的。
