New diagnostic tests for pneumonia: what is their role in clinical practice?

Thomas M File Jr, Thomas M File Jr

Abstract

The utility of diagnostic studies to determine the etiologic agents of community-acquired pneumonia has been controversial in part because of the lack of rapid, accurate, easily performed, and cost-effective methods. Advancements in molecular testing methods and biological markers are becoming available with marked expansion of diagnostic capability for infectious diseases. Subsequent studies and clinical experience will clarify their real clinical value.

Copyright © 2011 Elsevier Inc. All rights reserved.

References

    1. Fine M.J., Stone R.A., Singer D.E. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 1999;159:970–980.
    1. Read R.C. Evidence-based medicine: empiric antibiotic therapy in community-acquired pneumonia. J Infect. 1999;39:171–178.
    1. van der Eerden M.M., Vlaspolder F., de Graaff C.S. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomized study. Thorax. 2005;60(8):672–678.
    1. File T.M., Jr., Niederman M.S. Antimicrobial therapy of community-acquired pneumonia. Infect Dis Clin North Am. 2004;18:993.
    1. Sharuatzadeh M.R., Marrie T.J. Does sputum culture affect the management and/or the outcome of community-acquired pneumonia? East Mediterr Health J. 2009;15:792–799.
    1. Campbell S.G., Marrie T.J., Anstey R. The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia: a prospective observational study. Chest. 2003;123:1142–1150.
    1. Mandell L.A., Wunderink R.G., Anzueto A. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27.
    1. Yu V.L., Stout J.E. Rapid diagnostic testing for community acquired pneumonia: can innovative technology for clinical microbiology be exploited? Chest. 2009;136:1618–1621.
    1. Bartlett J.G. Decline in microbial studies for patients with pulmonary infections. Clin Infect Dis. 2004;39:170–172.
    1. Smith M.D., Derrington P., Evans P. Rapid diagnosis of bacteremic pneumococcal infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective, controlled clinical evaluation. J Clin Microbiol. 2003;41:2810–2813. 92.
    1. Gutierrez F., Masia M., Rodriguez J.C. Evaluation of the immunochromatographic binax NOW assay for detection of Streptococcus pneumoniae urinaryantigen in a prospective study of community-acquired pneumonia. Clin Infect Dis. 2003;36:286–292.
    1. Dominguez J., Blanco S., Rodrigo C. Usefulness of urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal pneumonia in children. J Clin Microbiol. 2003;41:2161–2163.
    1. Selickman J., Paxos M., File T.M., Jr. Performance measure of urinary antigen in patients with Streptococcus pneumoniae bacteremia. Diagn Microbiol Infect Dis. 2010;67(2):129–133.
    1. Samra Z., Shmuely H., Nahum E. Use of the NOW Streptococcus pneumoniae urinary antigen test in cerebrospinal fluid for rapid diagnosis of pneumococcal meningitis. Diagn Microbiol Infect Dis. 2003;45(4):237–240.
    1. Binax, Portland (ME). Binax NOW Streptococcus pneumoniae urinary antigen test package insert. Available at: Accessed November 1, 2011.
    1. Doern G.V. Detection of selected fastidious bacteria. Clin Infect Dis. 2000;30:166–173.
    1. Stout J.E., Yu V.L. Legionellosis. N Engl J Med. 1997;337:682–687.
    1. Waterer G.W., Baselski V.S., Wunderink R.G. Legionella and community-acquired pneumonia: a review of current diagnostic tests from a clinician’s viewpoint. Am J Med. 2001;110:41–48.
    1. Helbig J.H., Uldum S.A., Luck P.C. Detection of Legionella pneumophila antigen in urine samples by the Binax NOW immunochromatographic assay and comparison with both Binax Legionella Urinary Enzyme Immunoassay (EIA) and Biotest Legionella Urinary Antigen EIA. J Med Microbiol. 2001;50:509–516.
    1. Murdoch D.R., Laing R.T., Mills G.D. Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol. 2001;39:3495–3498.
    1. Shimada T., Noguchi Y., Jackson J.L. Systematic review and meta-analysis: urinary antigen tests for legionellosis. Chest. 2009;136:1576–1585.
    1. Mahlen S.D. Applications of molecular diagnostics. In: Mahon C.R., Lehman D.C., Manuselis G., editors. Textbook of diagnostic microbiology. 3rd edition. Saunders Elsevier; St Louis (MO): 2007. pp. 272–302.
    1. Nolte F.S., Caliendo A.M. Molecular detection and identification of microorganisms. In: Murray P.R., Baron E.J., Jorgensen J.H., editors. Manual of clinical microbiology. 9th edition. ASM Press; Washington, DC: 2007. pp. 218–244.
    1. Espy M.J., Uhl J.R., Sloan L.M. Real-time PCR in clinical microbiology: applications for routine laboratory testing. Clin Microbiol Rev. 2006;19:165–256.
    1. Nolte F.S. Molecular diagnostics for detection of bacterial and viral pathogens in community-acquired pneumonia. Clin Infect Dis. 2008;47(Suppl 3):S123–S126.
    1. teWitt R., van Leeuwen W.B. Specific diagnostic tests for atypical respiratory tract pathogens. Infect Dis Clin North Am. 2010;24:229.
    1. Chan Y.R., Morris A. Molecular diagnostic methods in pneumonia. Curr Opin Infect Dis. 2007;20:157–164.
    1. Murdoch D.R., Jennings L.C., Bhat N. Emerging advances in rapid diagnostic of respiratory infections. Infect Dis Clin North Am. 2010;24:791–807. 112, 713–727.
    1. Murdoch D.R., O’Brien K.L., Scott J.A. Breathing new life into pneumonia diagnostics. J Clin Microbiol. 2009;47:3405–3408.
    1. Butler J.C., Bosshardt S.C., Phelan M. Classical and latent class analysis evaluation of sputum polymerase chain reaction and urine antigen testing for diagnosis of pneumococcal pneumonia in adults. J Infect Dis. 2003;187:1416–1423.
    1. Saukkoriipi A., Palmu A., Kilpi T. Real-time quantitative PCR for the detection of Streptococcus pneumoniae in the middle ear fluid of children with acute otitis media. Mol Cell Probes. 2002;16:385–390.
    1. Falguera M., Lopez A., Nogues A. Evaluation of the polymerase chain reaction method for detection of Streptococcus pneumoniae DNA in pleural fluid samples. Chest. 2002;122:2212–2216.
    1. Yang S., Lin S., Khalil A. Quantitative PCR assay using sputum samples for rapid diagnosis of pneumococcal pneumonia in adult emergency department patients. J Clin Microbiol. 2005;43:3211–3226.
    1. Smith M.D., Sheppard C.L., Hogan A. Diagnosis of Streptococcus pneumoniae infections in adults with bacteremia and community-acquired pneumonia: clinical comparison of pneumococcal PCR and urinary antigen detection. J Clin Microbiol. 2009;47:1046–1049.
    1. Avni T., Mansur N., Leibovici L. PCR using blood for diagnosis of invasive pneumococcal disease: systematic review and meta-analysis. J Clin Microbiol. 2010;48:489–496.
    1. She R.C., Thurber A., Hymas W.C. Limited utility of culture for Mycoplasma pneumoniae and Chlamydophila pneumoniae for diagnosis of respiratory tract infections. J Clin Microbiol. 2010;48:3380–3382.
    1. Kerdsin A., Uchida R., Verathamjamrus C. Development of triplex SYBR green real-time PCR for detecting Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella spp. without extraction of DNA. Jpn J Infect Dis. 2010;63:173–180.
    1. Kim N.H., Lee J.A., Eun B.W. Comparison of polymerase chain reaction and the indirect particle agglutination antibody test for the diagnosis of Mycoplasma pneumoniae pneumonia in children. Pediatr Infect Dis J. 2007;26:897–903.
    1. Liu F.C., Chen P.Y., Huang F.L. Rapid diagnosis of Mycoplasma pneumoniae infection in children by polymerase chain reaction. J Microbiol Immunol Infect. 2007;40:507–512.
    1. Cloud J.L., Carroll K.C., Pixton P. Detection of Legionella species in respiratory specimens using PCR with sequencing confirmation. J Clin Microbiol. 2000;38:1709–1712.
    1. Diederen B.M., Van Der Eerden M.M., Vlaspolder F. Detection of respiratory viruses and Legionella spp. by real-time polymerase chain reaction in patients with community acquired pneumonia. Scand J Infect Dis. 2009;41(1):45–50.
    1. Morozumi M., Ito A., Murayama S.Y. Assessment of real-time PCR for diagnosis of Mycoplasma pneumoniae pneumonia in pediatric patients. Can J Microbiol. 2006;52:125–129.
    1. van Elden L.J., van Kraaij M.G., Nijhuis M. Polymerase chain reaction is more sensitive than viral culture and antigen testing for the detection of respiratory viruses in adults with hematological cancer and pneumonia. Clin Infect Dis. 2002;34(2):177–183.
    1. Fox J.D. Nucleic acid amplification tests for detection of respiratory viruses. J Clin Virol. 2007;40(Suppl 1):S15–S23.
    1. Mahony J.B. Detection of respiratory viruses by molecular methods. Clin Microbiol Rev. 2008;21:716–747.
    1. Templeton K.E., Scheltinga S.A., Beersma M.F. Rapid and sensitive method using multiplex real-time PCR for the diagnosis of infections by influenza a, influenza b, respiratory syncytial virus, parainfluenza viruses 1, 2, 3, and 4. J Clin Microbiol. 2004;42:1564–1569.
    1. Lieberman D., Shimoni A., Shemer-Avni Y. Respiratory viruses in adults with community-acquired pneumonia. Chest. 2010;138:811–816.
    1. Barry M.A. Review of influenza diagnosis and treatment. JAMA. 2010;304:671–678.
    1. Johansson N., Mats K., Tiveljung-Lindell A. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50:202–209.
    1. Niederman M.S. Viral community-acquired pneumonia. If we do not diagnose it and do not treat it, can it still hurt us? Chest. 2010;138:767–769.
    1. Guchev I.A., Yu V.L., Sinopalmikov A. Management of nonsevere pneumonia in military trainees with urinary antigen test for Streptococcus pneumoniae: an innovative approach to targeted therapy. Clin Infect Dis. 2005;40:1608–1616.
    1. Stralin K., Holmberg H. Usefulness of the Streptococcus pneumoniae urinary antigen test in the treatment of community-acquired pneumonia. Clin Infect Dis. 2005;41:1209–1210.
    1. Falguera M., Ruiz-Gonzalez A., Schoenenberger J.A. Empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalized patients with community-acquired pneumonia. Thorax. 2010;65:101–106.
    1. Oosterheert J.J., van Loon A.M., Schuurman R. Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis. 2005;41:1438–1444.
    1. Murdoch D.R. Impact of rapid microbiological testing on the management of lower respiratory tract infection. Clin Infect Dis. 2005;41:1445–1447.
    1. Yu V. Comparing narrow-spectrum antimicrobial therapy to standard of care in patients with community-acquired pneumonia. [Press release]. Available at: Accessed January 13, 2011.
    1. Niederman M.S. Biological markers to determine eligibility in trials for community-acquired pneumonia: a focus on procalcitonin. Clin Infect Dis. 2008;47:S127–S132.
    1. Schuetz P., Albrich W., Christ-Crain M. Procalcitonin for guidance of antibiotic therapy. Expert Rev Anti Infect Ther. 2010;8:575–587.
    1. Christ-Crain M., Jaccard-Stolz D., Bingisser R. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363:600.
    1. Christ-Crain M., Stolz D., Bingisser R. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174:84.
    1. Schuetz P., Christ-Crain M., Thomann R. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302:1059.
    1. Briel M., Schuetz P., Mueller B. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. 2008;168:2000–2007.
    1. Burkhardt O., Ewig S., Haagen U. Procalcitonin guidance and reduction of antibiotic use in acute respiratory tract infection. Eur Respir J. 2010;36:601.
    1. Masiá M., Gutiérrez F., Shum C. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patient’s outcome research team pneumonia severity index. Chest. 2005;128:2223.
    1. Boussekey N., Leroy O., Alfandari S. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia. Intensive Care Med. 2006;32:469.
    1. Schuetz P., Suter-Widmer I., Chaudri A. Prognostic value of procalcitonin in community-acquired pneumonia. Eur Respir J. 2011;37(2):384–392.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する