The role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2024-12-30 DOI:10.1186/s13054-024-05224-3

Francisco Javier Candel, Miguel Salavert, Rafael Cantón, José Luis del Pozo, Fátima Galán-Sánchez, David Navarro, Alejandro Rodríguez, Juan Carlos Rodríguez, Montserrat Rodríguez-Aguirregabiria, Borja Suberviola, Rafael Zaragoza

{"title":"The role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document","authors":"Francisco Javier Candel, Miguel Salavert, Rafael Cantón, José Luis del Pozo, Fátima Galán-Sánchez, David Navarro, Alejandro Rodríguez, Juan Carlos Rodríguez, Montserrat Rodríguez-Aguirregabiria, Borja Suberviola, Rafael Zaragoza","doi":"10.1186/s13054-024-05224-3","DOIUrl":null,"url":null,"abstract":"Rapid multiplex molecular syndromic panels (RMMSP) (3 or more pathogens and time-to-results < 6 h) allow simultaneous detection of multiple pathogens and genotypic resistance markers. Their implementation has revolutionized the clinical landscape by significantly enhancing diagnostic accuracy and reducing time-to-results in different critical conditions. The current revision is a comprehensive but not systematic review of the literature. We conducted electronic searches of the PubMed, Medline, Embase, and Google Scholar databases to identify studies assessing the clinical performance of RMMSP in critically ill patients until July 30, 2024. A multidisciplinary group of 11 Spanish specialists developed clinical questions pertaining to the indications and limitations of these diagnostic tools in daily practice in different clinical scenarios. The topics covered included pneumonia, sepsis/septic shock, candidemia, meningitis/encephalitis, and off-label uses of these RMMSP. These tools reduced the time-to-diagnosis (and therefore the time-to-appropriate treatment), reduced inappropriate empiric treatment and the length of antibiotic therapy (which has a positive impact on antimicrobial stewardship and might be associated with lower in-hospital mortality), may reduce the length of hospital stay, which could potentially lead to cost savings. Despite their advantages, these RMMSP have limitations that should be known, including limited availability, missed diagnoses if the causative agent or resistance determinants are not included in the panel, false positives, and codetections. Overall, the implementation of RMMSP represents a significant advancement in infectious disease diagnostics, enabling more precise and timely interventions. This document addresses relevant issues related to the use of RMMSP on different critically ill patient profiles, to standardize procedures, assist in making management decisions and help specialists to obtain optimal outcomes.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"35 1","pages":""},"PeriodicalIF":8.8000,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13054-024-05224-3","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Rapid multiplex molecular syndromic panels (RMMSP) (3 or more pathogens and time-to-results < 6 h) allow simultaneous detection of multiple pathogens and genotypic resistance markers. Their implementation has revolutionized the clinical landscape by significantly enhancing diagnostic accuracy and reducing time-to-results in different critical conditions. The current revision is a comprehensive but not systematic review of the literature. We conducted electronic searches of the PubMed, Medline, Embase, and Google Scholar databases to identify studies assessing the clinical performance of RMMSP in critically ill patients until July 30, 2024. A multidisciplinary group of 11 Spanish specialists developed clinical questions pertaining to the indications and limitations of these diagnostic tools in daily practice in different clinical scenarios. The topics covered included pneumonia, sepsis/septic shock, candidemia, meningitis/encephalitis, and off-label uses of these RMMSP. These tools reduced the time-to-diagnosis (and therefore the time-to-appropriate treatment), reduced inappropriate empiric treatment and the length of antibiotic therapy (which has a positive impact on antimicrobial stewardship and might be associated with lower in-hospital mortality), may reduce the length of hospital stay, which could potentially lead to cost savings. Despite their advantages, these RMMSP have limitations that should be known, including limited availability, missed diagnoses if the causative agent or resistance determinants are not included in the panel, false positives, and codetections. Overall, the implementation of RMMSP represents a significant advancement in infectious disease diagnostics, enabling more precise and timely interventions. This document addresses relevant issues related to the use of RMMSP on different critically ill patient profiles, to standardize procedures, assist in making management decisions and help specialists to obtain optimal outcomes.

查看原文本刊更多论文

快速多重分子症候群在危重病人感染临床管理中的作用：专家意见文件

快速多重分子综合征组（RMMSP）（3种或更多病原体，结果时间< 6小时）允许同时检测多种病原体和基因型耐药标记。他们的实施通过显著提高诊断准确性和缩短不同危急情况下的结果时间，彻底改变了临床景观。当前的修订是对文献的全面而非系统的回顾。我们对PubMed、Medline、Embase和谷歌Scholar数据库进行了电子检索，以确定评估RMMSP在2024年7月30日之前在危重患者中的临床表现的研究。一个由11名西班牙专家组成的多学科小组就这些诊断工具在不同临床情况下的日常实践中的适应症和局限性提出了临床问题。涵盖的主题包括肺炎，败血症/感染性休克，念珠菌，脑膜炎/脑炎，以及这些RMMSP的标签外使用。这些工具缩短了诊断时间（从而缩短了适当治疗的时间），减少了不适当的经验性治疗和抗生素治疗的时间（这对抗菌素管理有积极影响，并可能与较低的住院死亡率有关），可能缩短住院时间，从而可能节省费用。尽管这些RMMSP具有优势，但它们也有应该知道的局限性，包括有限的可用性，如果致病因子或耐药性决定因素未包括在小组中，则漏诊，假阳性和共检。总体而言，RMMSP的实施代表了传染病诊断方面的重大进步，使干预措施更加精确和及时。本文件阐述了在不同危重患者档案中使用RMMSP的相关问题，以规范程序，协助制定管理决策并帮助专家获得最佳结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.