Molecular diagnostics in severe pneumonia: a new dawn or false promise?

Morris, Andrew Conway; Bos, Lieuwe D. J.; Nseir, Saad

doi:10.1007/s00134-022-06722-0

Cited by 9 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the detection of microbial nucleic acids is becoming more common, their place in the management of infections in general, and in bacterial infections specifically, remains uncertain and it is not yet well standardized [ 14 ]. Pathogen-specific biomarkers, like direct antigen tests, are already widely used in the critically ill.…”

Section: Pathogen-specific and Host-response Biomarkersmentioning

confidence: 99%

How to use biomarkers of infection or sepsis at the bedside: guide to clinicians

et al. 2023

Self Cite

View full text Add to dashboard Cite

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In this context, biomarkers could be considered as indicators of either infection or dysregulated host response or response to treatment and/or aid clinicians to prognosticate patient risk. More than 250 biomarkers have been identified and evaluated over the last few decades, but no biomarker accurately differentiates between sepsis and sepsis-like syndrome. Published data support the use of biomarkers for pathogen identification, clinical diagnosis, and optimization of antibiotic treatment. In this narrative review, we highlight how clinicians could improve the use of pathogen-specific and of the most used host-response biomarkers, procalcitonin and C-reactive protein, to improve the clinical care of patients with sepsis. Biomarker kinetics are more useful than single values in predicting sepsis, when making the diagnosis and assessing the response to antibiotic therapy. Finally, integrated biomarker-guided algorithms may hold promise to improve both the diagnosis and prognosis of sepsis. Herein, we provide current data on the clinical utility of pathogen-specific and host-response biomarkers, offer guidance on how to optimize their use, and propose the needs for future research. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06956-y.

show abstract

Section: Pathogen-specific and Host-response Biomarkersmentioning

confidence: 99%

How to use biomarkers of infection or sepsis at the bedside: guide to clinicians

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…TAC may be a helpful addition to the ‘Sepsis 6’ investigations and interventions for children with suspected sepsis in the PICU [ 42 ]. In other situations, diagnostic tests are requested as a rule-in test, where there is a moderate to high pre-test probability, but morbidity and mortality outcomes may be moderate [ 43 ]. The use of TAC appeared to be greatest as a rule-out test so that children with viral LRTI, with possible bacterial co-infection, could have earlier antimicrobial therapy cessation.…”

Section: Discussionmentioning

confidence: 99%

“…The use of TAC appeared to be greatest as a rule-out test so that children with viral LRTI, with possible bacterial co-infection, could have earlier antimicrobial therapy cessation. This approach has been previously highlighted as a benefit of diagnostic arrays, and clinicians have reported they would consider antimicrobial cessation based on negative results [ 14 , 43 ]. If a narrower range of pathogens were incorporated on the array there would be less certainty in ruling out the potential of co-infection.…”

Section: Discussionmentioning

confidence: 99%

A qualitative investigation of paediatric intensive care staff attitudes towards the diagnosis of lower respiratory tract infection in the molecular diagnostics era

Clark

Morris

Kanaris

et al. 2023

Intensive Care Med. Paediatr. Neonatal

Self Cite

View full text Add to dashboard Cite

Background In the past decade, molecular diagnostic syndromic arrays incorporating a range of bacterial and viral pathogens have been described. It is unclear how paediatric intensive care unit (PICU) staff diagnose lower respiratory tract infection (LRTI) and integrate diagnostic array results into antimicrobial decision-making. Methods An online survey with eleven questions was distributed throughout paediatric intensive care societies in the UK, continental Europe and Australasia with a total of 755 members. Participants were asked to rate the clinical factors and investigations they used when prescribing for LRTI. Semi-structured interviews were undertaken with staff who participated in a single-centre observational study of a 52-pathogen diagnostic array. Results Seventy-two survey responses were received; most responses were from senior doctors. Whilst diagnostic arrays were used less frequently than routine investigations (i.e. microbiological culture), they were of comparable perceived utility when making antimicrobial decisions. Prescribers reported that for arrays to be clinically impactful, they would need to deliver results within 6 h for stable patients and within 1 h for unstable patients to inform their immediate decision to prescribe antimicrobials. From 16 staff interviews, we identified that arrays were helpful for the diagnosis and screening of bacterial LRTI. Staff reported it could be challenging to interpret results in some cases due to the high sensitivity of the test. Therefore, results were considered within the context of the patient and discussed within the multidisciplinary team. Conclusions Diagnostic arrays were considered of comparable value to microbiological investigations by PICU prescribers. Our findings support the need for further clinical and economic evaluation of diagnostic arrays in a randomised control trial. Trial registration Clinicaltrials.gov, NCT04233268. Registered on 18 January 2020.

show abstract

“…As a result of this tension between excessive and inappropriate antibiotics, there has been considerable focus on trying to improve diagnostic processes in patients with suspected ventilator-associated pneumonia, aiming to return accurate results rapidly to the bedside to enable faster, more precise decision-making. Much of this work has focused on improving microbial diagnostics, seeking to obviate the inherent delays and insensitivity of culturebased methods [9]. Excellent rule-out diagnostic performance can be achieved with alveolar cytokine concentrations [10,11]; however, when deployed in a randomised evaluation, they failed to impact on antimicrobial prescribing [11].…”

Section: Pneumoniamentioning

confidence: 99%

“…More promising data have arisen from the use of syndromic pathogen-focused molecular diagnostics which allow rapid identification of specific microbes and major antimicrobial resistance mechanisms [12,13], although the impact on antimicrobial prescribing remains relatively modest. Where minimally invasive samples such as tracheal aspirate are used, the combination of proximal tract colonisation and highly sensitive molecular tests may even drive increased antimicrobial use [9]. The ideal diagnostic would combine both sensitive and specific markers of infectious inflammation with an accurate and rapid indicator of the causative micro-organism.…”

Section: Pneumoniamentioning

confidence: 99%