Molecular diagnostics in severe pneumonia: a new dawn or false promise?

Abstract

Pneumonia is one of the most common causes for acute respiratory failure and subsequent intensive care admission [1]. Critically ill patients are also at increased risk for nosocomial pneumonia. There is no gold standard diagnosis for pneumonia as a range of clinical and radiological pneumonia mimics can develop in critically ill patients [2], likely resulting in overtreatment with broad spectrum antibiotics. Previous studies showed that bacteria were detected by culture for one half of community acquired pneumonia (CAP), and one-third of suspected ventilator-associated pneumonia (VAP) episodes. One of the challenges lies in microbiological confirmation of pneumonia as conventional culture techniques are slow and insensitive, especially after antimicrobial exposure. Molecular diagnostics may solve this problem by providing rapid results that are less influenced by inter-current antibiotics. We will here discuss the implementation of these rapid tests into clinical research and practice.