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Development and implementation of a customised rapid syndromic diagnostic test for severe pneumonia

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: Development and implementation of a customised rapid syndromic diagnostic test for severe pneumonia
Συγγραφείς: Conway Morris A, Navapurkar V, Bartholdson Scott J, Maes M, Hellyer TP, Higginson E, Forrest S, Pereira-Dias J, Parmar S, Heasman-Hunt E, Polgarova P, Brown J, Titti L, Smith WPW, Scott J, Rostron A, Routledge M, Sapsford D, Torok ME, McMullan R, Enoch DA, Wong V, Curran MD, Brown NM, Simpson AJ, Herre J, Dougan G
Πηγή: Wellcome Open Research, 2022
Στοιχεία εκδότη: F1000 Research Ltd
Έτος έκδοσης: 2022
Συλλογή: Newcastle University Library ePrints Service
Περιγραφή: © 2022 Navapurkar V et al. Background: The diagnosis of pneumonia has been hampered by a reliance on bacterial cultures which take several days to return a result, and are frequently negative. In critically ill patients this leads to the use of empiric, broad-spectrum antimicrobials and compromises good antimicrobial stewardship. The objective of this study was to establish the performance of a syndromic molecular diagnostic approach, using a custom TaqMan array card (TAC) covering 52 respiratory pathogens, and assess its impact on antimicrobial prescribing. Methods: The TAC was validated against a retrospective multi-centre cohort of broncho-alveolar lavage samples. The TAC was assessed prospectively in patients undergoing investigation for suspected pneumonia, with a comparator cohort formed of patients investigated when the TAC laboratory team were unavailable. Co-primary outcomes were sensitivity compared to conventional microbiology and, for the prospective study, time to result. Metagenomic sequencing was performed to validate findings in prospective samples. Antibiotic free days (AFD) were compared between the study cohort and comparator group. Results: 128 stored samples were tested, with sensitivity of 97% (95% confidence interval (CI) 88-100%). Prospectively, 95 patients were tested by TAC, with 71 forming the comparator group. TAC returned results 51 hours (interquartile range 41-69 hours) faster than culture and with sensitivity of 92% (95% CI 83-98%) compared to conventional microbiology. 94% of organisms identified by sequencing were detected by TAC. There was a significant difference in the distribution of AFDs with more AFDs in the TAC group (p=0.02). TAC group were more likely to experience antimicrobial de-escalation (odds ratio 2.9 (95%1.5-5.5)). Conclusions: Implementation of a syndromic molecular diagnostic approach to pneumonia led to faster results, with high sensitivity and impact on antibiotic prescribing.
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Relation: https://eprints.ncl.ac.uk/305750; https://eprints.ncl.ac.uk/fulltext.aspx?url=305750/8256FA97-D18A-4EEE-8D49-6A76E8D1C6D9.pdf&pub_id=305750
Διαθεσιμότητα: https://eprints.ncl.ac.uk/305750
Rights: https://creativecommons.org/licenses/by/4.0/
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  Data: Development and implementation of a customised rapid syndromic diagnostic test for severe pneumonia
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  Data: <searchLink fieldCode="AR" term="%22Conway+Morris+A%22">Conway Morris A</searchLink><br /><searchLink fieldCode="AR" term="%22Navapurkar+V%22">Navapurkar V</searchLink><br /><searchLink fieldCode="AR" term="%22Bartholdson+Scott+J%22">Bartholdson Scott J</searchLink><br /><searchLink fieldCode="AR" term="%22Maes+M%22">Maes M</searchLink><br /><searchLink fieldCode="AR" term="%22Hellyer+TP%22">Hellyer TP</searchLink><br /><searchLink fieldCode="AR" term="%22Higginson+E%22">Higginson E</searchLink><br /><searchLink fieldCode="AR" term="%22Forrest+S%22">Forrest S</searchLink><br /><searchLink fieldCode="AR" term="%22Pereira-Dias+J%22">Pereira-Dias J</searchLink><br /><searchLink fieldCode="AR" term="%22Parmar+S%22">Parmar S</searchLink><br /><searchLink fieldCode="AR" term="%22Heasman-Hunt+E%22">Heasman-Hunt E</searchLink><br /><searchLink fieldCode="AR" term="%22Polgarova+P%22">Polgarova P</searchLink><br /><searchLink fieldCode="AR" term="%22Brown+J%22">Brown J</searchLink><br /><searchLink fieldCode="AR" term="%22Titti+L%22">Titti L</searchLink><br /><searchLink fieldCode="AR" term="%22Smith+WPW%22">Smith WPW</searchLink><br /><searchLink fieldCode="AR" term="%22Scott+J%22">Scott J</searchLink><br /><searchLink fieldCode="AR" term="%22Rostron+A%22">Rostron A</searchLink><br /><searchLink fieldCode="AR" term="%22Routledge+M%22">Routledge M</searchLink><br /><searchLink fieldCode="AR" term="%22Sapsford+D%22">Sapsford D</searchLink><br /><searchLink fieldCode="AR" term="%22Torok+ME%22">Torok ME</searchLink><br /><searchLink fieldCode="AR" term="%22McMullan+R%22">McMullan R</searchLink><br /><searchLink fieldCode="AR" term="%22Enoch+DA%22">Enoch DA</searchLink><br /><searchLink fieldCode="AR" term="%22Wong+V%22">Wong V</searchLink><br /><searchLink fieldCode="AR" term="%22Curran+MD%22">Curran MD</searchLink><br /><searchLink fieldCode="AR" term="%22Brown+NM%22">Brown NM</searchLink><br /><searchLink fieldCode="AR" term="%22Simpson+AJ%22">Simpson AJ</searchLink><br /><searchLink fieldCode="AR" term="%22Herre+J%22">Herre J</searchLink><br /><searchLink fieldCode="AR" term="%22Dougan+G%22">Dougan G</searchLink>
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  Data: © 2022 Navapurkar V et al. Background: The diagnosis of pneumonia has been hampered by a reliance on bacterial cultures which take several days to return a result, and are frequently negative. In critically ill patients this leads to the use of empiric, broad-spectrum antimicrobials and compromises good antimicrobial stewardship. The objective of this study was to establish the performance of a syndromic molecular diagnostic approach, using a custom TaqMan array card (TAC) covering 52 respiratory pathogens, and assess its impact on antimicrobial prescribing. Methods: The TAC was validated against a retrospective multi-centre cohort of broncho-alveolar lavage samples. The TAC was assessed prospectively in patients undergoing investigation for suspected pneumonia, with a comparator cohort formed of patients investigated when the TAC laboratory team were unavailable. Co-primary outcomes were sensitivity compared to conventional microbiology and, for the prospective study, time to result. Metagenomic sequencing was performed to validate findings in prospective samples. Antibiotic free days (AFD) were compared between the study cohort and comparator group. Results: 128 stored samples were tested, with sensitivity of 97% (95% confidence interval (CI) 88-100%). Prospectively, 95 patients were tested by TAC, with 71 forming the comparator group. TAC returned results 51 hours (interquartile range 41-69 hours) faster than culture and with sensitivity of 92% (95% CI 83-98%) compared to conventional microbiology. 94% of organisms identified by sequencing were detected by TAC. There was a significant difference in the distribution of AFDs with more AFDs in the TAC group (p=0.02). TAC group were more likely to experience antimicrobial de-escalation (odds ratio 2.9 (95%1.5-5.5)). Conclusions: Implementation of a syndromic molecular diagnostic approach to pneumonia led to faster results, with high sensitivity and impact on antibiotic prescribing.
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