Introduction. Pneumonia is highly prevalent in intensive care units (ICUs), with high associated mortality. Empirical treatment prioritizes breadth of coverage while awaiting laboratory diagnosis, often at the expense of antimicrobial stewardship. Microarrays use multiple parallel polymerase chain reactions to enable a rapid syndromic approach to laboratory diagnosis. Aim. To evaluate the clinical and laboratory implications of introducing a bespoke 22-pathogen TaqMan Array Card (TAC) for rapid pathogen detection in deep respiratory samples from adult ICUs. Methodology. TAC results from all ICU patients prospectively tested over a 9-month period at Cambridge’s Clinical Microbiology and Public Health Laboratory were compared to those of corresponding conventional microbiological assays (culture-, PCR- or serology-based) in terms of result agreement and time-to-result availability. Clinical impact was assessed by retrospective review of medical records. Results. Seventy-one patients were included [45 (63 %) male, median age 59). Overall result agreement was 94 %, with TAC detecting more pathogens than conventional methods. TAC detected Streptococcus pneumoniae more readily than culture (7 vs 0 cases; P=0.02). TAC did not detect Aspergillus spp. in eight culture- or galactomannan-positive cases. The median turnaround time (1 day) was significantly shorter than that of bacterial/fungal culture, Pneumocystis jirovecii PCR and galactomannan testing (each 3 days; P<0.001), atypical bacteria serology (13 days; P<0.001) and Mycobacterium tuberculosis culture (46 days; P<0.001). Earlier result availability prompted discontinuation of unnecessary antimicrobials in 15/71 (21 %) cases, but had no bearing on patient isolation/deisolation. Conclusion. TAC provided greater overall yield of pathogen detection and faster turnaround times, permitting earlier discontinuation of unnecessary antimicrobials.

中文翻译：

---

评估使用22种病原菌TaqMan阵列卡快速诊断重症监护中的呼吸道病原体。

介绍。肺炎在重症监护病房（ICU）中高度流行，且死亡率很高。在等待实验室诊断之前，经验治疗会优先考虑覆盖范围，这通常以牺牲抗菌素管理为代价。微阵列使用多个平行的聚合酶链反应，以实现用于实验室诊断的快速综合症方法。目标。为了评估引入定制的22病原TaqMan阵列卡（TAC）来快速检测来自成人ICU的深呼吸样本中的病原体的临床和实验室意义。方法。在结果一致性和时间方面，将在剑桥临床微生物学和公共卫生实验室进行了9个月测试的所有ICU患者的TAC结果与相应的常规微生物测定（基于培养，PCR或血清学）的TAC结果进行了比较。结果可用性。通过回顾性医疗记录评估临床影响。结果。包括71名患者[男性（45（63％），中位年龄59）。总体结果一致性为94％，TAC检测到的病原体比传统方法更多。与培养相比，TAC更容易检测到肺炎链球菌（7比0；P = 0.02）。TAC未检测到曲霉 spp。在八个文化或半乳甘露聚糖阳性病例中。中位周转时间（1天）明显短于细菌/真菌培养，吉氏肺孢子虫PCR和半乳甘露聚糖检测（每3天；P <0.001），非典型细菌血清学（13天；P <0.001）和结核分枝杆菌培养的时间（46天；P <0.001）。较早的结果可用性提示在15/71（21％）的病例中停用了不必要的抗生素，但与患者的隔离/分离无关。结论。TAC提供了更高的病原体检测总产量和更快的周转时间，从而可以更早地停用不必要的抗菌剂。