Can multiplex molecular panels of microbial pathogens transform respiratory care in critically ill patients?

Introduction: Diagnosing severe pneumonia accurately is often difficult because its clinical symptoms overlap with other respiratory illnesses. Treatment of severe lower respiratory tract infection (LRTI) should start early. Rapid identification of responsible microorganisms and appropriate, not overly broad, antibiotic therapy is required to optimize prognosis. Unfortunately, the causative pathogen is often unidentified in pneumonia patients, and conventional bacterial cultures lack sensitivity and have slow turnaround times. Multiplex PCR (mPCR) respiratory panels, which quickly detect multiple bacterial pathogens, some common respiratory viruses, and key resistance genes, have become commercially available and may help achieve these objectives.

Areas covered: The authors will describe the available biological and clinical data on the benefits of mPCR in severe LRTI.

Expert opinion: mPCR offers early pathogen and resistance detection. However, mPCR panels do not detect all bacterial pathogens and may not differentiate between colonizing and infecting organisms. Detectable resistance genes do not always indicate phenotypic resistance. It should only be used in patients with adequate lower respiratory tract (LRT) samples. Additionally, evidence on whether mPCR panels improve antimicrobial use and patient outcomes remains limited and conflicting. This review provides a thorough overview of the rationale and clinical evidence for the use of mPCR panels for the detection of viral and bacterial pathogens in pneumonia diagnosis and management, as well as future research directions. [Figure: see text].