This is a narrative review on the potential of rapid and point-of-care microbiological testing in pneumonia patients, focusing particularly on hospital-acquired and ventilator-associated pneumonia, which have substantial mortality and diverse microbiology. This work is written from a United Kingdom perspective, but much of it is generalizable internationally. In a world where antimicrobial resistance is a major international threat, the use of rapid molecular diagnostics has great potential to improve both the management of pneumonia patients and the stewardship of antibiotics. Rapid tests potentially can distinguish patients with bacterial versus viral infection and can swiftly identify bacterial pathogens and their resistances. We seek to answer the question: “Can such tests be used as an antibiotic guardian?” Their availability at the bedside rather than in the laboratory should best ensure that results are swiftly used to optimize patient management but will raise new challenges, not the least with respect to maintaining quality control and microbiology/infection control input. A further challenge lies in assessing the degree of trust that treating clinicians will place in these molecular diagnostic tests, particularly when early de-escalation of antibiotic therapy is indicated.

中文翻译：

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呼吸道感染的快速和即时检测：抗生素的守护者？

这是一篇关于肺炎患者快速和即时医疗微生物检测潜力的叙述性综述，特别关注医院获得性和呼吸机相关性肺炎，它们具有很高的死亡率和多种微生物学。本书是从英国的角度撰写的，但其中很多是可以在国际上推广的。在抗药性成为主要国际威胁的世界中，快速分子诊断的使用具有巨大的潜力，可以改善肺炎患者的管理和抗生素的管理。快速测试潜在地可以区分细菌感染和病毒感染，并可以快速识别细菌病原体及其耐药性。我们寻求回答以下问题：“这种检测可以用作抗生素的监护人吗？” 它们在床头而不是在实验室中的可用性应该最好地确保将结果快速用于优化患者管理，但将带来新的挑战，尤其是在保持质量控制和微生物/感染控制输入方面。进一步的挑战在于评估临床医生在这些分子诊断测试中的信任程度，尤其是在指示早期降低抗生素治疗水平时。