SELECTED ARTICLES FROM THE RECENT LITERATURE 2005
12/20/05
An improved method for diagnosing the etiology of community acquired pneumonia
Summary
Background - It is generally agreed that there are still major limitations in establishing the nature of the microbial etiology of community-acquired pneumonia (CAP). Establishing typical bacterial offenders by traditional culture techniques often takes too long (days). Also, usual clinical culture techniques generally do not detect viral or atypical bacterial species.
Findings - Templeton et al of the Leiden Univ Medical Center in Holland found that a microbiologic diagnosis was established by a real-time polymerase chain reaction (PCR) in 76% of the cases of CAP as compared to diagnose by traditional culture techniques in 50% of CAP cases. In particular, PCR identified pathogens in 87% of CAP in older individuals and in 90% of those with severe CAP.
Another advantage of the PCR approach was that definitive identification was obtained in as short as 6 hours, as compared to well over 24 hours for identification using traditional cultures.
Reference
Clin Infect Dis 2005;41:345-51
Editor's Comments
These exciting preliminary findings, if confirmed in larger patient groups and by other groups, could represent a major advance in the management of CAP. At present, empiric antibiotic treatment is given for days until an etiology can be established by traditional culture methods (and sometimes the etiology is not identified at all). It remains to be determined whether the PCR technique utilized in this study can be used accurately and cost-effectively in the average clinical microbiology lab servicing community practitioners.
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