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Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited?
Two nonsynchronous events have affected the management of community-acquired pneumonia (CAP): spiraling empiricism for CAP and the “golden era” of clinical microbiology. The development of broad-spectrum antibiotics has led to widespread empiric use without ascertaining the etiology of the infecting...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The American College of Chest Physicians. Published by Elsevier Inc.
2009
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7130296/ https://www.ncbi.nlm.nih.gov/pubmed/19995763 http://dx.doi.org/10.1378/chest.09-0939 |
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author | Yu, Victor L. Stout, Janet E. |
author_facet | Yu, Victor L. Stout, Janet E. |
author_sort | Yu, Victor L. |
collection | PubMed |
description | Two nonsynchronous events have affected the management of community-acquired pneumonia (CAP): spiraling empiricism for CAP and the “golden era” of clinical microbiology. The development of broad-spectrum antibiotics has led to widespread empiric use without ascertaining the etiology of the infecting microbe. Unfortunately, this approach clashes with the second event, which is the advent of molecular-based microbiology that can identify the causative pathogen rapidly at the point of care. The urinary antigen is a most effective rapid test that has allowed targeted therapy for Legionnaire disease at the point of care. The high specificity (> 90%) allows the clinician to administer appropriate anti-Legionella therapy based on a single rapid test; however, its low sensitivity (76%) means that a notable number of cases of Legionnaire disease will go undiagnosed if other tests, especially culture, are not performed. Further, culture for Legionella is not readily available. If a culture is not performed, epidemiologic identification of the source of the bacterium cannot be ascertained by molecular fingerprinting of the patient and the putative source strain. We recommend resurrection of the basic principles of infectious disease, which are to identify the microbial etiology of the infection and to use narrow, targeted antimicrobial therapy. To reduce antimicrobial overuse with subsequent antimicrobial resistance, these basic principles must be applied in concert with traditional and newer tests in the clinical microbiology laboratory. |
format | Online Article Text |
id | pubmed-7130296 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2009 |
publisher | The American College of Chest Physicians. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-71302962020-04-08 Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited? Yu, Victor L. Stout, Janet E. Chest Commentary Two nonsynchronous events have affected the management of community-acquired pneumonia (CAP): spiraling empiricism for CAP and the “golden era” of clinical microbiology. The development of broad-spectrum antibiotics has led to widespread empiric use without ascertaining the etiology of the infecting microbe. Unfortunately, this approach clashes with the second event, which is the advent of molecular-based microbiology that can identify the causative pathogen rapidly at the point of care. The urinary antigen is a most effective rapid test that has allowed targeted therapy for Legionnaire disease at the point of care. The high specificity (> 90%) allows the clinician to administer appropriate anti-Legionella therapy based on a single rapid test; however, its low sensitivity (76%) means that a notable number of cases of Legionnaire disease will go undiagnosed if other tests, especially culture, are not performed. Further, culture for Legionella is not readily available. If a culture is not performed, epidemiologic identification of the source of the bacterium cannot be ascertained by molecular fingerprinting of the patient and the putative source strain. We recommend resurrection of the basic principles of infectious disease, which are to identify the microbial etiology of the infection and to use narrow, targeted antimicrobial therapy. To reduce antimicrobial overuse with subsequent antimicrobial resistance, these basic principles must be applied in concert with traditional and newer tests in the clinical microbiology laboratory. The American College of Chest Physicians. Published by Elsevier Inc. 2009-12 2015-12-16 /pmc/articles/PMC7130296/ /pubmed/19995763 http://dx.doi.org/10.1378/chest.09-0939 Text en © 2009 The American College of Chest Physicians Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Commentary Yu, Victor L. Stout, Janet E. Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited? |
title | Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited? |
title_full | Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited? |
title_fullStr | Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited? |
title_full_unstemmed | Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited? |
title_short | Rapid Diagnostic Testing for Community-Acquired Pneumonia: Can Innovative Technology for Clinical Microbiology Be Exploited? |
title_sort | rapid diagnostic testing for community-acquired pneumonia: can innovative technology for clinical microbiology be exploited? |
topic | Commentary |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7130296/ https://www.ncbi.nlm.nih.gov/pubmed/19995763 http://dx.doi.org/10.1378/chest.09-0939 |
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