Rapid diagnosis of acute pediatric respiratory infections with Point-of-Care and multiplex molecular testing.

IF 5.4 2区 医学 Q1 INFECTIOUS DISEASES
Jane M Caldwell, Claudia Mily Espinosa, Ritu Banerjee, Joseph B Domachowske
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引用次数: 0

Abstract

Acute infections of the respiratory tract are very common in pediatric patients, with an estimated global incidence of 17.2 billion cases in 2019. Accurate and timely diagnosis and treatment of acute respiratory infections can prevent progression to more serious pathologies, especially in the young, elderly, immunocompromised, and other high-risk groups. Due to the significant increase in the number of multiplex molecular tests available, there are now many diagnostic options which generate results within minutes or hours, many of which can be performed at point-of-care or near-patient rather than being sent out to a centralized laboratory. Rapid molecular single- or multiplex testing conducted at point-of-care or near-patient offers the potential to improve timely and accurate diagnosis, decrease inappropriate antibiotic use, decrease reliance on chest radiographs, improve timely antiviral administration, reduce the length of hospital stay, reduce the number of clinical visits, and, ultimately, improve patient outcomes. Optimal use of user-friendly multiplex molecular panels also has the potential to improve regional and global disease surveillance and to fill gaps that exist in our understanding of the epidemiology of respiratory infections. These potential benefits, however, come with limitations. For example, use of multiplex PCR assays is not always a cost effective approach. Despite their potential, there are clinical and/or laboratory circumstances where their use becomes cost prohibitive. Another recognized limitation of multiplex PCR assays is that the pathogen detected may not be the cause of a patient's current symptom complex. Such false positive results may occur because the assays are designed to detect pathogen-specific nucleic acid (which may be residual from a prior illness), rather than replication competent pathogens, or because some pathogens can be present without causing symptomatic infection. Further study is needed to determine optimal use of these tests across different patient groups and settings. Incorporating recommendations for best practice use of multiplex molecular assays into clinical guidelines helps offer a framework for their most appropriate use in the diagnosis of pediatric acute respiratory infections.

用即时护理和多重分子检测快速诊断急性儿科呼吸道感染。
急性呼吸道感染在儿科患者中非常常见,2019年全球发病率估计为172亿例。准确和及时的诊断和治疗急性呼吸道感染可以防止发展为更严重的病理,特别是在年轻人、老年人、免疫功能低下者和其他高危人群中。由于多重分子检测的数量显著增加,现在有许多诊断选择可以在几分钟或几小时内产生结果,其中许多可以在护理点或患者附近进行,而不是送到集中实验室。在护理点或病人附近进行的快速分子单一或多重检测有可能改善及时和准确的诊断,减少不适当的抗生素使用,减少对胸部x线片的依赖,改善及时的抗病毒药物管理,缩短住院时间,减少临床就诊次数,并最终改善患者的预后。对用户友好的多重分子面板的最佳使用也有可能改善区域和全球疾病监测,并填补我们对呼吸道感染流行病学的理解中的空白。然而,这些潜在的好处也有局限性。例如,使用多重PCR测定并不总是一种具有成本效益的方法。尽管它们具有潜力,但在临床和/或实验室环境中,它们的使用成本过高。多重PCR检测的另一个公认的局限性是,检测到的病原体可能不是患者当前症状复杂的原因。之所以会出现这种假阳性结果,是因为检测的目的是检测病原体特异性核酸(可能是先前疾病的残留),而不是检测具有复制能力的病原体,或者是因为某些病原体可能存在而不会引起症状性感染。需要进一步的研究来确定这些测试在不同患者群体和环境中的最佳使用。将多重分子测定的最佳实践使用建议纳入临床指南有助于为其在儿科急性呼吸道感染诊断中的最适当使用提供框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Infection
Infection 医学-传染病学
CiteScore
12.50
自引率
1.30%
发文量
224
审稿时长
6-12 weeks
期刊介绍: Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.
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