Point-Counterpoint: Large Multiplex PCR Panels Should Be First-Line Tests for Detection of Respiratory and Intestinal Pathogens
Point-Counterpoint: Large Multiplex PCR Panels Should Be First-Line Tests for Detection of Respiratory and Intestinal Pathogens
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DOI：
10.1128/jcm.00382-15
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发表时间：
2015-10-01
影响因子：
9.4
通讯作者：
McAdam, Alexander J.
中科院分区：
文献类型：
--
作者：
Schreckenberger, Paul C.;McAdam, Alexander J.
2008年引入了第一个FDA批准的用于大量呼吸道病原体的多重PCR面板。从那时起，用于检测几种呼吸道和胃肠道病原体的其他PCR面板已获得FDA批准并可商购，并且可能会有更多此类面板可用。这些检测方法可检测12至20种病原体，其中一些病原体通常会导致不同的感染表现，尽管它们会感染相同的器官系统。其中一些测试是劳动密集型的，而另一些则需要很少的劳动力，并且所有这些测试都是昂贵的，无论是对实验室还是对患者或保险公司来说。它们包括一组测试，这些测试具有有限的或没有选择将执行哪些测试的选项。实验室和医院采用不同的策略来提供这些检测。一些人已经实施了限制测试使用的策略，例如限制患者可以被测试的频率，限制对特定患者群体的测试（例如，免疫功能低下的患者），或提供教育，以鼓励在使用大型多重面板之前使用较便宜的测试。其他人提供了这些测定而不限制其使用，要么依赖于订购提供商进行良好的判断，要么因为这些测定被认为适合于一线诊断测试。在这篇文章中，Loyola大学医学中心的Paul Schreckenberger解释了为什么他的实验室不受限制地提供这些检测。波士顿儿童医院的亚历克斯·麦克亚当解释了对使用这些检测作为一线检测的担忧，以及为什么对它们的使用进行一些限制可能是合适的。
The first FDA-approved multiplex PCR panel for a large number of respiratory pathogens was introduced in 2008. Since then, other PCR panels for detection of several respiratory and gastrointestinal pathogens have been approved by the FDA and are commercially available, and more such panels are likely to become available. These assays detect 12 to 20 pathogens, and some include pathogens that typically cause different manifestations of infection, although they infect the same organ system. Some of these tests are labor-intensive, while others require little labor, and all of them are expensive, both for the laboratory and for the patient or insurer. They include a bundle of tests with limited or no options for selecting which tests will be performed. Laboratories and hospitals have adopted different strategies for offering these assays. Some have implemented strategies to limit the use of the tests, such as limiting the frequency with which patients can be tested, restricting testing to specific groups of patients (e.g., immunocompromised patients), or providing education to encourage the use of less expensive tests before using large multiplex panels. Others have offered these assays without limiting their use, either relying on the ordering provider to exercise good judgment or because such assays are thought to be appropriate for first-line diagnostic testing. In this Point-Counterpoint, Paul Schreckenberger of Loyola University Medical Center explains why his laboratory offers these assays without restriction. Alex McAdam of Boston's Children Hospital explains the concerns about the use of these assays as first-line tests and why some limitations on their use might be appropriate.