USA: The American Thoracic Society (ATS) has released the latest clinical practice guideline on community-acquired pneumonia. The guideline, published in the American Journal of Respiratory and Critical Care Medicine, addresses the use of nucleic acid-based testing for non-influenza viral pathogens.
Community-acquired pneumonia (CAP) is a heterogeneous illness caused by a wide range of respiratory pathogens, prominently including viruses. However, the only viral pathogen addressed by the 2019 clinical practice guideline was influenza. The panel determined that, given the increasing recognition of non-influenza viral causes of CAP and the expanded availability of diagnostic tests among clinicians, it was necessary to update the previous guideline to help guide treatment.
The guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation or GRADE framework. The panel made the following recommendations regarding the use of nucleic acid-based viral diagnostic testing for viral pathogens other than influenza in patients with suspected CAP:
In outpatients with suspected CAP, we suggest not performing routine nucleic acid-based testing of respiratory samples for viral pathogens other than influenza.
In hospitalized patients with suspected CAP, we suggest nucleic acid-based testing of respiratory samples for viral pathogens other than influenza only in patients who meet one of the following conditions:
Patients with severe CAP (i.e., patients with >1 major or >3 minor criteria [2]) and
Immunocompromised patients (including those with neutropenia, those undergoing active cancer therapy, those with a history of solid-organ or blood component transplantation, those with advanced HIV disease, or those with a history of chronic use of immunosuppressive medications, including systemic corticosteroids).
"Molecular diagnostics for lung infections are rapidly evolving. We will continue to monitor developments to determine when additional updates are appropriate," noted guideline panelists Scott Evans and Charles Dela Cruz. "We also look forward to reviewing more literature that directly link the use of molecular diagnostics on important outcomes, such as death, morbidity, antimicrobial drug use patterns, and costs."
Reference;
"Nucleic Acid–based Testing for Noninfluenza Viral Pathogens in Adults with Suspected Community-acquired Pneumonia: An Official American Thoracic Society Clinical Practice Guideline," is published in the American Journal of Respiratory and Critical Care Medicine.
DOI: https://www.atsjournals.org/doi/full/10.1164/rccm.202102-0498ST