Are We Ready for Novel Detection Methods to Treat Respiratory Pathogens in Hospital-Acquired Pneumonia?
Are We Ready for Novel Detection Methods to Treat Respiratory Pathogens in Hospital-Acquired Pneumonia?
复制标题
DOI：
10.1093/cid/cir054
复制
发表时间：
2011-05-01
影响因子：
11.8
通讯作者：
Bonomo, Robert A.
中科院分区：
文献类型：
--
作者：
Endimiani, Andrea;Hujer, Kristine M.;Bonomo, Robert A.
医院获得性肺炎是传染病中最困难的治疗挑战之一。许多研究表明，及时采取适当的针对病原体的治疗可以挽救生命。由于培养和抗菌药物敏感性测试的结果可能需要 48 小时或更长时间，因此医生目前依靠临床、流行病学和人口统计因素来协助选择针对抗生素耐药病原体的经验疗法。目前，正在开发许多快速分子测试来识别病原体和抗菌素耐药性遗传决定因素的存在（例如，GeneXpert [Cepheid]、ResPlex [Qiagen]、FilmArray [Idaho Technologies] 和 Microarray [Check-Points]）。在这篇综述中，研究了分子诊断对早期识别和表征导致医院获得性细菌性肺炎的病原体的潜在影响。此外，还介绍了聚合酶链反应和电喷雾电离质谱新技术的前景，并讨论了其在肺炎诊断中的前景用途。肺部微生物组的复杂性对临床医生来说是一个新的挑战，但即使这些技术不断进步，许多问题仍然存在。
Hospital-acquired pneumonia represents one of the most difficult treatment challenges in infectious diseases. Many studies suggest that the timely administration of appropriate, pathogen-directed therapy can be lifesaving. Because results of culture and antimicrobial susceptibility testing can take 48 h or longer, physicians currently rely on clinical, epidemiological, and demographic factors to assist with the choice of empiric therapy for antibiotic-resistant pathogens. At present, a number of rapid molecular tests are being developed that identify pathogens and the presence of genetic determinants of antimicrobial resistance (eg, GeneXpert [Cepheid], ResPlex [Qiagen], FilmArray [Idaho Technologies], and Microarray [Check-Points]). In this review, the potential impact that molecular diagnostics has to identify and characterize pathogens that cause hospital-acquired bacterial pneumonia at an early stage is examined. In addition, a perspective on a novel technology, polymerase chain reaction followed by electrospray ionization mass spectrometry, is presented, and its prospective use in the diagnosis of pneumonia is also discussed. The complexities of the pulmonary microbiome represent a novel challenge to clinicians, but many questions still remain even as these technologies improve.