van de Maat Josephine S, Redfern Andrew, Bacha Tigist, Schouten Jeroen, Ruizendaal Esmée
Department of Pediatrics, Amalia Children's Hospital.
Radboud Community for Infectious Diseases.
Curr Opin Pediatr. 2025 Oct 1;37(5):517-526. doi: 10.1097/MOP.0000000000001484. Epub 2025 Sep 4.
Routine diagnostic tests for childhood pneumonia lack the accuracy to identify bacterial pneumonia, leading to inappropriate antibiotic prescription. Novel tests are being developed. Optimizing diagnostic strategies using available diagnostic tools and exploring the role of new tests is essential to improve antimicrobial stewardship (AMS) in children. This review provides an overview of advances in diagnostic testing for pediatric pneumonia and discusses how strategies can be optimized in different settings in order to improve AMS.
All currently available tests for bacterial pneumonia are limited in their diagnostic accuracy. However, in settings with high baseline antibiotic prescription, routine diagnostics such as CRP or PCT-guided prescription can improve antibiotic use. Among the innovative tests, lung ultrasound with computer-aided detection and prediction models combining multiple tests holds most promise for low-resource settings. For high-resource settings, RNA signatures and next-generation sequencing are promising developments. The impact of innovative tests on AMS remains to be evaluated.
Robust diagnostic and contextual research is needed to develop new diagnostic tests and to optimize current strategies for bacterial pneumonia in children. In order to tailor diagnostic approaches to specific settings, broad impact studies and stratification of risk groups are crucial.
儿童肺炎的常规诊断测试缺乏识别细菌性肺炎的准确性，导致抗生素处方不合理。新型测试正在研发中。利用现有诊断工具优化诊断策略并探索新测试的作用对于改善儿童抗菌药物管理（AMS）至关重要。本综述概述了小儿肺炎诊断测试的进展，并讨论了如何在不同环境中优化策略以改善抗菌药物管理。
目前所有用于细菌性肺炎的测试在诊断准确性方面都存在局限性。然而，在基线抗生素处方率较高的环境中，诸如CRP或PCT引导的处方等常规诊断方法可以改善抗生素的使用。在创新测试中，具有计算机辅助检测的肺部超声以及结合多种测试的预测模型在资源匮乏地区最具前景。对于资源丰富地区，RNA特征和下一代测序是有前景的发展方向。创新测试对抗菌药物管理的影响仍有待评估。
需要进行强有力的诊断和背景研究，以开发新的诊断测试并优化当前针对儿童细菌性肺炎的策略。为了针对特定环境调整诊断方法，广泛的影响研究和风险群体分层至关重要。
