Pintea-Simon Ionela-Anca, Bancu Ligia, Mare Anca Delia, Ciurea Cristina Nicoleta, Toma Felicia, Man Adrian
Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mures, Romania.
Department of Internal Medicine M3, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mures, Romania.
Antibiotics (Basel). 2024 Aug 25;13(9):805. doi: 10.3390/antibiotics13090805.
With approximately half a billion events per year, lower respiratory tract infections (LRTIs) represent a major challenge for the global public health. Among LRTI cases, those caused by Gram-negative bacteria (GNB) are associated with a poorer prognostic. Standard-of-care etiologic diagnostics is lengthy and difficult to establish, with more than half of cases remaining microbiologically undocumented. Recently, syndromic molecular diagnostic panels became available, enabling simultaneous detection of tens of pathogen-related and antimicrobial-resistance genetic markers within a few hours. In this narrative review, we summarize the available data on the performance of molecular diagnostics in GNB pneumonia, highlighting the main strengths and limitations of these assays, as well as the main factors influencing their clinical utility. We searched MEDLINE and Web of Science databases for relevant English-language articles. Molecular assays have higher analytical sensitivity than cultural methods, and show good agreement with standard-of-care diagnostics regarding detection of respiratory pathogens, including GNB, and identification of frequent patterns of resistance to antibiotics. Clinical trials reported encouraging results on the usefulness of molecular assays in antibiotic stewardship. By providing early information on the presence of pathogens and their probable resistance phenotypes, these assays assist in the choice of targeted therapy, in shortening the time from sample collection to appropriate antimicrobial treatment, and in reducing unnecessary antibiotic use.
下呼吸道感染（LRTIs）每年发生约5亿例，是全球公共卫生面临的一项重大挑战。在LRTI病例中，由革兰氏阴性菌（GNB）引起的感染预后较差。标准的病因诊断耗时且难以确立，超过半数的病例在微生物学上仍无记录。最近，综合征分子诊断平台问世，能够在数小时内同时检测数十种与病原体相关和抗微生物耐药性的基因标记物。在这篇叙述性综述中，我们总结了关于分子诊断在GNB肺炎中表现的现有数据，突出了这些检测方法的主要优势和局限性，以及影响其临床应用的主要因素。我们在MEDLINE和科学网数据库中检索了相关的英文文章。分子检测方法比培养方法具有更高的分析灵敏度，并且在检测包括GNB在内的呼吸道病原体以及识别常见的抗生素耐药模式方面，与标准护理诊断显示出良好的一致性。临床试验报告了分子检测方法在抗生素管理方面有用性的令人鼓舞的结果。通过提供关于病原体存在及其可能的耐药表型的早期信息，这些检测方法有助于选择靶向治疗，缩短从样本采集到适当抗菌治疗的时间，并减少不必要的抗生素使用。
