Dessajan Julien, Timsit Jean-François
Assistance Publique Hôpitaux de Paris (AP-HP), Medical and Infectious Diseases Intensive Care Unit, Bichat Claude-Bernard Hospital, Paris Cité University, 46 Rue Henri Huchard, 75018 Paris, France.
Mixt Research Unit (UMR) 1137, Infection, Antimicrobials, Modelization, Epidemiology (IAME), Institut National de la Recherche Médicale (INSERM), Paris Cité University, 75018 Paris, France.
Antibiotics (Basel). 2024 Jan 18;13(1):95. doi: 10.3390/antibiotics13010095.
Pneumonia is a common and severe illness that requires prompt and effective management. Advanced, rapid, and accurate tools are needed to diagnose patients with severe bacterial pneumonia, and to rapidly select appropriate antimicrobial therapy, which must be initiated within the first few hours of care. Two multiplex molecular tests, Unyvero HPN and FilmArray Pneumonia+ Panel, have been developed using the multiplex polymerase chain reaction (mPCR) technique to rapidly identify pathogens and their main antibiotic resistance mechanisms from patient respiratory specimens. Performance evaluation of these tests showed strong correlations with reference techniques. However, good knowledge of their indications, targets, and limitations is essential. Collaboration with microbiologists is, therefore, crucial for their appropriate use. Under these conditions, and with standardized management, these rapid tests can improve the therapeutic management of severe pneumonia faster, more precisely, and with narrow-spectrum antibiotic therapy. Further randomized controlled trials are needed to address the many unanswered questions about multiplex rapid molecular testing during the diagnosis and the management of severe pneumonia. This narrative review will address the current knowledge, advantages, and disadvantages of these tests, and propose solutions for their routine use.
肺炎是一种常见且严重的疾病,需要及时有效的治疗。诊断重症细菌性肺炎患者并迅速选择合适的抗菌治疗需要先进、快速且准确的工具,抗菌治疗必须在护理的最初几个小时内开始。已使用多重聚合酶链反应(mPCR)技术开发了两种多重分子检测方法,即Unyvero HPN和FilmArray肺炎+检测板,以从患者呼吸道标本中快速鉴定病原体及其主要抗生素耐药机制。这些检测方法的性能评估显示与参考技术有很强的相关性。然而,充分了解它们的适应症、靶点和局限性至关重要。因此,与微生物学家合作对于正确使用这些检测方法至关重要。在这些条件下,并通过标准化管理,这些快速检测方法可以更快、更精确地改善重症肺炎的治疗管理,并采用窄谱抗生素治疗。需要进一步的随机对照试验来解决在重症肺炎的诊断和治疗过程中关于多重快速分子检测的许多未解决问题。本叙述性综述将阐述这些检测方法的现有知识、优点和缺点,并提出其常规使用的解决方案。