The clinical impact of rapid molecular diagnostics in pneumonia

Abstract

Pneumonia is a leading cause of mortality and morbidity worldwide. Novel syndromic molecular platforms have been developed which test for many different pneumonia causing organisms. These platforms have been shown to deliver reliable microbiological results in fraction of the time of conventional diagnostics with much greater sensitivity. Such investigations could revolutionise the care of patients with respiratory illness by influencing antibiotic prescribing and infection control decisions in near real-time. This thesis describes two clinical impact trials of molecular point-of-care testing (mPOCT) for respiratory pathogens in pneumonia.
The Severe Acute Respiratory Illness Point-Of-Care (SARIPOC) trial was a randomised controlled trial which recruited adults with pneumonia in critical care. 200 patients were randomised to either standard clinical care or a molecular stewardship investigation including molecular testing with the Filmarray pneumonia panel, serum procalcitonin, and clinical infection advice. A contributory pathogen was identified in a 71% of mPOCT patients, compared to 51% of standard care patients. The median time to result was 1.7 hours for mPOCT and 66.7 hours for standard care. As a result of these increased, rapid detections, we demonstrated that 51% more patients in the mPOCT arm went onto optimal therapy for a microbiological result, with no observed difference in safety outcomes.
The CoV-19 POC study was a non-randomised interventional trial, which recruited 500 adults presenting to secondary care with suspected SARS-CoV-2 infection. Patients were tested with the QIAstat-Dx respiratory SARS-CoV-2 panel within the first 24 hours of admission and compared to 555 contemporaneously identified control patients, who were admitted via the same admission pathways but were tested by standard laboratory PCR. Median time to results was quicker in the mPOCT tested group (by 19.6 hours), and as a result, patients spent almost 20.8 fewer hours in cohort assessment areas, where they could potentially be exposed to SARS-CoV-2 infection, before arriving in their definitive clinical area. These two trials demonstrate that mPOCT for respiratory pathogens are associated with reduced time to results compared to conventional diagnostics and with improvement in clinical care, including timely infection control decisions and in the appropriate use of antibiotics. Routine use of mPOCT for SARS-CoV-2 is now widespread in the UK. Further confirmatory trials are needed to before mPOCT for pneumonia can become standard practice in UK hospitals.

More information

Identifiers

ORCID for Tristan Clark: orcid.org/0000-0001-6026-5295

Catalogue record

Export record