Evidence map›Paper›PMID 26747825›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2016

Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia.

Naomi J Gadsby, Clark D Russell, Martin P McHugh, Harriet Mark, Andrew Conway Morris, Ian F Laurenson, Adam T Hill, Kate E Templeton

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04153682 (Impact of a Strategy Combining the Rapid Polymerase Chain Reaction Platform FilmArray® and the Intervention of an Antimicrobial Stewardship Team in Hospital-acquired Pneumonia), which is not on this map. Cited by 208 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
208citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04153682 nacompletednot on this mapstarted 2020, after this paper: background citation

Impact of a Strategy Combining the Rapid Polymerase Chain Reaction Platform FilmArray® and the Intervention of an Antimicrobial Stewardship Team in Hospital-acquired Pneumonia : a Randomized Controlled Trial.

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2020 to 2023Enrolled116ConditionsHospital-acquired PneumoniaArmsRapid Diagnostic Testing, Antimicrobial stewardship
3 · Its place in the literature

Who cites it

208 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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  7. Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2017
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  19. Accuracy of comprehensive PCR analysis of nasopharyngeal and oropharyngeal swabs for CT-scan-confirmed pneumonia in elderly patients: a prospective cohort study.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2019
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148 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Naomi J GadsbyMedical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh.
Clark D RussellMedical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh.
Martin P McHughMedical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh.
Harriet MarkMedical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh.
Andrew Conway MorrisDepartment of Anaesthesia, University of Cambridge.
Ian F LaurensonMedical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh.
Adam T HillRespiratory Medicine, Royal Infirmary of Edinburgh, United Kingdom.
Kate E TempletonMedical Microbiology, Department of Laboratory Medicine, Royal Infirmary of Edinburgh.

Funding

Chief Scientist Office ETM/250
6 · The paper itself

Abstract

backgroundThe frequent lack of a microbiological diagnosis in community-acquired pneumonia (CAP) impairs pathogen-directed antimicrobial therapy. This study assessed the use of comprehensive multibacterial, multiviral molecular testing, including quantification, in adults hospitalized with CAP.

methodsClinical and laboratory data were collected for 323 adults with radiologically-confirmed CAP admitted to 2 UK tertiary care hospitals. Sputum (96%) or endotracheal aspirate (4%) specimens were cultured as per routine practice and also tested with fast multiplex real-time polymerase-chain reaction (PCR) assays for 26 respiratory bacteria and viruses. Bacterial loads were also calculated for 8 bacterial pathogens. Appropriate pathogen-directed therapy was retrospectively assessed using national guidelines adapted for local antimicrobial susceptibility patterns.

resultsComprehensive molecular testing of single lower respiratory tract (LRT) specimens achieved pathogen detection in 87% of CAP patients compared with 39% with culture-based methods. Haemophilus influenzae and Streptococcus pneumoniae were the main agents detected, along with a wide variety of typical and atypical pathogens. Viruses were present in 30% of cases; 82% of these were codetections with bacteria. Most (85%) patients had received antimicrobials in the 72 hours before admission. Of these, 78% had a bacterial pathogen detected by PCR but only 32% were culture-positive (P < .0001). Molecular testing had the potential to enable de-escalation in number and/or spectrum of antimicrobials in 77% of patients.

conclusionsComprehensive molecular testing significantly improves pathogen detection in CAP, particularly in antimicrobial-exposed patients, and requires only a single LRT specimen. It also has the potential to enable early de-escalation from broad-spectrum empirical antimicrobials to pathogen-directed therapy.

Indexed as

Community-Acquired InfectionsPneumonia, BacterialPneumonia, ViralAgedAnti-Bacterial AgentsBacterial LoadFemaleHaemophilus influenzaeHumansMaleMicrobial Sensitivity TestsMiddle AgedMolecular Diagnostic TechniquesPolymerase Chain ReactionRetrospective StudiesStreptococcus pneumoniaeAnti-Bacterial Agentsbacterial loadcommunity-acquired pneumoniamolecular testingPCRviral

Identifiers

PMID26747825
PMCPMC4787606

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.