Bacterial multiplex polymerase chain reaction tests for the diagnosis and management of pneumonia: ready for prime time?

These factors contribute to both inadequate empiric therapy and overuse of broad-spectrum antibiotics, which can negatively impact outcomes.

这些因素导致经验性治疗不足和广谱抗生素的过度使用，这可能会对结果产生负面影响。

Recently, multiplex polymerase chain reaction (mPCR) assays capable of rapidly detecting multiple bacterial respiratory pathogens and resistance genes have emerged.

最近，能够快速检测多种细菌性呼吸道病原体及其耐药基因的多重聚合酶链反应（mPCR）检测方法已经出现。

However, their clinical utility in pneumonia management remains uncertain.

然而，这些检测方法在肺炎管理中的临床效用仍然不确定。

To assess the utility of bacterial mPCR assays in pneumonia diagnosis, their impact on antimicrobial usage, and their effect on patient outcomes.

评估细菌多重PCR检测在肺炎诊断中的效用、对抗菌药物使用的影响以及对患者预后的影响。

Methods

A comprehensive literature review was conducted using MEDLINE to identify observational studies and randomised controlled trials (RCTs) evaluating the accuracy and clinical impact of bacterial mPCR tests for pneumonia.

使用MEDLINE进行了全面的文献回顾，以识别评估细菌多重PCR检测在肺炎诊断中的准确性和临床影响的观察性研究和随机对照试验(RCTs)。

Results

Bacterial mPCR assays demonstrate high sensitivity for pathogen detection, rapid turnaround compared to conventional cultures, and the ability to identify many common resistance genes.

细菌多重PCR检测对病原体检测显示出高敏感性，与传统培养相比具有快速的周转时间，并且能够识别许多常见的耐药基因。

They may also improve pathogen detection in patients who received empirical antibiotics prior to specimen collection.

它们还可能提高在采集样本前已经接受经验性抗生素治疗的患者中的病原体检测率。

However, mPCRs do not detect all potential pathogens, cannot reliably differentiate colonisation from infection, and may show discordance between genetic and phenotypic resistance. mPCR panels also generally require lower respiratory tract specimens, limiting their utility since many pneumonia patients cannot produce adequate sputum.

然而，mPCRs无法检测所有潜在病原体，无法可靠地区分定植与感染，并且可能在遗传和表型抗药性之间显示出不一致。mPCR面板通常需要下呼吸道标本，限制了它们的效用，因为许多肺炎患者无法产生足够的痰液。

Observational studies and RCTs suggest that mPCR may help optimise antibiotic selection, but RCTs have not clearly demonstrated reductions in overall antibiotic use or improved clinical outcomes including mortality.

观察性研究和随机对照试验表明，mPCR可能有助于优化抗生素的选择，但随机对照试验尚未明确证明抗生素总体使用量的减少或临床结果的改善，包括死亡率。

Implementation of mPCR without structured antimicrobial stewardship may limit clinical impact.

在缺乏结构化的抗菌药物管理计划的情况下实施多重PCR可能会限制其临床影响。

Conclusions

Bacterial mPCR assays offer rapid and sensitive pathogen detection, but their integration into pneumonia management requires careful consideration of clinical context and expert antimicrobial stewardship guidance.

细菌多重PCR检测提供了快速且敏感的病原体检测，但它们在肺炎管理中的应用需要仔细考虑临床背景和专家抗菌药物管理指导。

Future research should focus on optimising their diagnostic and therapeutic applications, evaluating cost-effectiveness, and assessing patient-centered outcomes.

未来的研究应集中于优化其诊断和治疗应用，评估成本效益，并评估以患者为中心的结果。