title: The potential of molecular diagnostics and serum procalcitonin levels to change the antibiotic management of community-acquired pneumonia.
abstract: Two diagnostic bundles were compared in 127 evaluable patients admitted with community-acquired pneumonia (CAP). Diagnostic modalities in all patients included cultures of sputum (if obtainable) and blood, urine for detection of the antigens of Streptococcus pneumoniae and Legionella pneumophila, and nasal swabs for PCR probes for S. pneumoniae and Staphylococcus aureus. At least one procalcitonin level was measured in all patients. For virus detection, patients were randomized to either a 5-virus, lab-generated PCR panel or the broader and faster FilmArray PCR panel. Overall, an etiologic diagnosis was established in 71% of the patients. A respiratory virus was detected in 39%. The potential for improved antibiotic stewardship was evident in 25 patients with only detectable respiratory virus and normal levels of PCT.
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA. Electronic address: david.gilbert@providence.org.
authors.forename: David
authors.initials: D
authors.lastname: Gilbert
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Gita
authors.initials: G
authors.lastname: Gelfer
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Lian
authors.initials: L
authors.lastname: Wang
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Jillian
authors.initials: J
authors.lastname: Myers
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Bajema
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Johnston
authors.affiliation: Providence Portland Medical Center, Portland, OR, USA.
authors.forename: James
authors.initials: J
authors.lastname: Leggett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000097:blood / Q000652:urine; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002116:Calcitonin / Q000097:blood*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009297:Nasal Mucosa / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D016133:Polymerase Chain Reaction; D011897:Random Allocation; D044967:Serum / Q000737:chemistry; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014780:Viruses / Q000145:classification / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D002116:Calcitonin
keywords: Community-acquired pneumonia; Diagnostic bundles; FilmArray; Molecular diagnostics; Procalcitonin