Walker Alyssa M, Timbrook Tristan T, Hommel Benjamin, Prinzi Andrea M
bioMerieux, 69280 Marcy L'etoile, France.
Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA.
Diagnostics (Basel). 2024 Apr 2;14(7):752. doi: 10.3390/diagnostics14070752.
The advent of rapid molecular microbiology testing has revolutionized infectious disease diagnostics and is now impacting pneumonia diagnosis and management. Molecular platforms offer highly multiplexed assays for diverse viral and bacterial detection, alongside antimicrobial resistance markers, providing the potential to significantly shape patient care. Despite the superiority in sensitivity and speed, debates continue regarding the clinical role of multiplex molecular testing, notably in comparison to standard methods and distinguishing colonization from infection. Recent guidelines endorse molecular pneumonia panels for enhanced sensitivity and rapidity, but implementation requires addressing methodological differences and ensuring clinical relevance. Diagnostic stewardship should be leveraged to optimize pneumonia testing, emphasizing pre- and post-analytical strategies. Collaboration between clinical microbiologists and bedside providers is essential in developing implementation strategies to maximize the clinical utility of multiplex molecular diagnostics in pneumonia. This narrative review explores these multifaceted issues, examining the current evidence on the clinical performance of multiplex molecular assays in pneumonia, and reflects on lessons learned from previous microbiological advances. Additionally, given the complexity of pneumonia and the sensitivity of molecular diagnostics, diagnostic stewardship is discussed within the context of current literature, including implementation strategies that consider pre-analytical and post-analytical modifications to optimize the clinical utility of advanced technologies like multiplex PCR.
快速分子微生物检测技术的出现彻底改变了传染病的诊断方式，如今正影响着肺炎的诊断和治疗。分子检测平台可提供用于多种病毒和细菌检测以及抗菌药物耐药性标志物检测的高度多重检测方法，为显著改善患者护理提供了可能。尽管在灵敏度和速度方面具有优势，但关于多重分子检测的临床作用仍存在争议，尤其是与标准方法相比以及区分定植与感染方面。近期指南认可分子肺炎检测组合可提高灵敏度和检测速度，但实施过程需要解决方法学差异问题并确保临床相关性。应利用诊断管理来优化肺炎检测，强调分析前和分析后的策略。临床微生物学家与床边医护人员之间的合作对于制定实施策略以最大化多重分子诊断在肺炎中的临床效用至关重要。本叙述性综述探讨了这些多方面的问题，审视了关于多重分子检测在肺炎中临床性能的现有证据，并反思了从以往微生物学进展中吸取的经验教训。此外，鉴于肺炎的复杂性和分子诊断的敏感性，在当前文献背景下讨论了诊断管理，包括考虑分析前和分析后改进措施的实施策略，以优化多重PCR等先进技术的临床效用。
