Scholarlink

Background <p>Traditional culture-based diagnostics for emergency-department (ED) pneumonia are slow and season-agnostic, delaying targeted therapy. We evaluated whether season-tailored multiplex PCR panels accelerate pathogen identification and improve antibiotic stewardship.</p> Methods <p>In a single-center, prospective study, adults with radiographically confirmed pneumonia were enrolled consecutively and allocated by a rotating week-on/week-off schedule to either a seasonal PCR panel or conventional diagnostics. Primary outcomes were (i) time to final pathogen report and (ii) diagnostic yield (≥ 1 pathogen detected). Secondary outcomes included empiric-antibiotic appropriateness within 24&#xa0;h, regimen changes ≤ 72&#xa0;h, antibiotic duration, length of stay (LOS) and 30-day mortality.</p> Results <p>Among 282 analyzable patients (spring = 140; autumn–winter = 142), PCR slashed turnaround time from 48&#xa0;h to 12&#xa0;h in spring and from 50&#xa0;h to 14&#xa0;h in autumn–winter (median difference − 36&#xa0;h, 95% CI: − 42 to − 30; <i>p</i> &lt; 0.001). Diagnostic yield rose from 61.6 to 80.6% in spring and from 56.8 to 80.0% in winter (risk differences 19.0 pp and 22.3 pp, respectively; both <i>p</i> &lt; 0.01). In the winter cohort, guideline-concordant empiric therapy increased (78.7% vs. 64.9%; +13.8 pp) and antibiotic changes ≤ 72&#xa0;h fell (14.7% vs. 28.4%; − 13.7 pp). Mean antibiotic courses shortened by 1.5–1.7 days across seasons, while LOS showed a non-significant 1–2-day reduction. Thirty-day mortality did not differ. Effects were consistent in older adults (≥ 65 y) and patients with COPD.</p> Conclusions <p>Locally adapted, season-specific multiplex PCR panels deliver near-four-fold faster, higher-yield pathogen detection and support measurable stewardship gains without compromising safety. Implementation in other settings should consider local pathogen seasonality, workflow, and cost structures.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Rapid, season-specific PCR testing versus traditional diagnostics for pneumonia in the emergency department

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年8月2日

查看全文
  • Yangxiu Yu,
  • Qiuping Li

摘要

Background

Traditional culture-based diagnostics for emergency-department (ED) pneumonia are slow and season-agnostic, delaying targeted therapy. We evaluated whether season-tailored multiplex PCR panels accelerate pathogen identification and improve antibiotic stewardship.

Methods

In a single-center, prospective study, adults with radiographically confirmed pneumonia were enrolled consecutively and allocated by a rotating week-on/week-off schedule to either a seasonal PCR panel or conventional diagnostics. Primary outcomes were (i) time to final pathogen report and (ii) diagnostic yield (≥ 1 pathogen detected). Secondary outcomes included empiric-antibiotic appropriateness within 24 h, regimen changes ≤ 72 h, antibiotic duration, length of stay (LOS) and 30-day mortality.

Results

Among 282 analyzable patients (spring = 140; autumn–winter = 142), PCR slashed turnaround time from 48 h to 12 h in spring and from 50 h to 14 h in autumn–winter (median difference − 36 h, 95% CI: − 42 to − 30; p < 0.001). Diagnostic yield rose from 61.6 to 80.6% in spring and from 56.8 to 80.0% in winter (risk differences 19.0 pp and 22.3 pp, respectively; both p < 0.01). In the winter cohort, guideline-concordant empiric therapy increased (78.7% vs. 64.9%; +13.8 pp) and antibiotic changes ≤ 72 h fell (14.7% vs. 28.4%; − 13.7 pp). Mean antibiotic courses shortened by 1.5–1.7 days across seasons, while LOS showed a non-significant 1–2-day reduction. Thirty-day mortality did not differ. Effects were consistent in older adults (≥ 65 y) and patients with COPD.

Conclusions

Locally adapted, season-specific multiplex PCR panels deliver near-four-fold faster, higher-yield pathogen detection and support measurable stewardship gains without compromising safety. Implementation in other settings should consider local pathogen seasonality, workflow, and cost structures.