Rapid and Point-of-Care Testing in Respiratory Tract Infections: An Antibiotic Guardian?

This is a narrative review on the potential of rapid and point-of-care microbiological testing in pneumonia patients, focusing particularly on hospital-acquired and ventilator-associated pneumonia, which have substantial mortality and diverse microbiology. This work is written from a United Kingdom perspective, but much of it is generalizable internationally. In a world where antimicrobial resistance is a major international threat, the use of rapid molecular diagnostics has great potential to improve both the management of pneumonia patients and the stewardship of antibiotics. Rapid tests potentially can distinguish patients with bacterial versus viral infection and can swiftly identify bacterial pathogens and their resistances. We seek to answer the question: "Can such tests be used as an antibiotic guardian?" Their availability at the bedside rather than in the laboratory should best ensure that results are swiftly used to optimize patient management but will raise new challenges, not the least with respect to maintaining quality control and microbiology/infection control input. A further challenge lies in assessing the degree of trust that treating clinicians will place in these molecular diagnostic tests, particularly when early de-escalation of antibiotic therapy is indicated.

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Copyright © 2020 American Chemical Society.

Déclaration de conflit d'intérêts

The authors declare the following competing financial interest(s): Z.D.: Nothing to declare. V.I.E. has received research support, speaking honoraria, consultancy fees, and in-kind contributions from Curetis GmbH, BioMrieux, and Oxford Nanopore. J.O.G.: Has received research funding, financial support for attending conferences and free flowcells and reagents from Oxford Nanopore Technologies. Is a consultant for Simcere Diagnostics. V.G.: Has been paid to give presentations for Gilead, Biomrieux, Pfizer, and MSD. D.M.L.: Advisory Boards or ad-hoc consultancy Accelerate, Allecra, Antabio, Centauri, Entasis, Integra-Holdings, Meiji, Melinta, Menarini, Mutabilis, Nordic, ParaPharm, Pfizer, QPEX, Roche, Shionogi, T.A.Z., Tetraphase, VenatoRx, Wockhardt, Zambon. Paid lectures: Astellas, bioMerieux, Beckman Coulter, Cardiome, Cepheid, Merck/MSD, Menarini, Nordic, Pfizer, and Shionogi. Relevant shareholdings or options: Dechra, GSK, Merck, Perkin Elmer, Pfizer, T.A.Z, amounting to less than 10% of portfolio value.