Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Department of Medical Biotechnologies, University of Siena, Siena, Italy.
Expert Rev Mol Diagn. 2022 Jan;22(1):49-60. doi: 10.1080/14737159.2022.2018302. Epub 2021 Dec 28.
Pneumonia is one of the main causes of mortality associated with infectious diseases worldwide. Several challenges have been identified in the management of patients with pneumonia, ranging from accurate and cost-effective microbiological investigations, prompt and adequate therapeutic management, and optimal treatment duration.
In this review, an updated summary on the current management of pneumonia patients is provided and the epidemiological issues of infectious respiratory diseases, which in the current pandemic situation are of particular concern, are addressed. The clinical and microbiological approaches to pneumonia diagnosis are reviewed, including discussion about the new molecular assays pointing out both their strengths and limitations. Finally, the current recommendations about antibiotic treatment are examined and discussed depending on the epidemiological contexts, including those with high prevalence of multidrug-resistant bacteria.
We claim that rapid diagnostic tests, if well-positioned in the diagnostic workflow and reserved for the subset of patients who could most benefit from these technologies, may represent an interesting and feasible tool to optimize timing of targeted treatments especially in terms of early de-escalation or discontinuation of antibiotic therapy.
肺炎是全球与传染病相关的主要死亡原因之一。在肺炎患者的管理中,已经确定了一些挑战,包括准确且具有成本效益的微生物学调查、及时和充分的治疗管理以及最佳的治疗持续时间。
本文提供了对肺炎患者当前管理的最新总结,并讨论了传染病性呼吸道疾病的流行病学问题,在当前大流行情况下,这些问题尤其令人关注。本文回顾了肺炎诊断的临床和微生物学方法,包括讨论新的分子检测方法,指出它们的优缺点。最后,根据流行病学背景,包括那些耐多药细菌流行率高的背景,检查和讨论了目前关于抗生素治疗的建议。
我们认为,如果快速诊断检测能够在诊断工作流程中找准定位,并保留给最能从这些技术中受益的患者亚群,那么它们可能是优化靶向治疗时机的一种有趣且可行的工具,尤其是在早期降级或停止抗生素治疗方面。