CHEST Guidelines-Serial-Testing-With-TB-Interferon-γ-Release-

Serial-Testing-With-TB-Interferon-γ-Release-

Pdf Summary

The editorial addresses concerns regarding diagnostic practices for catheter-related bloodstream infections (CRBSIs) and ventilator-associated pneumonia (VAP). It questions whether reduced diagnostic tests for CRBSIs might be due to decreased frequency or changing practices influenced by reporting and reimbursement pressures. For VAP, there's concern about delayed treatment due to similar pressures, despite the importance of prompt antibiotic administration. The article suggests using an approach similar to pulmonary embolism management, integrating pretest probabilities with diagnostic tests, while acknowledging inherent uncertainties.<br /><br />In another section, the use of interferon-gamma release assays (IGRAs) for tuberculosis (TB) testing, especially among healthcare workers, is scrutinized. Despite being more specific than traditional tuberculin skin tests (TSTs), IGRAs show high variability in results, such as conversions and reversions. Factors affecting this include assay reproducibility, pre-analytical delays, and variations in immune response. The article criticizes the routine implementation of IGRAs for serial testing in low-risk populations, suggesting the need for more nuanced guidelines and possibly redirecting resources to high-burden TB regions instead.<br /><br />Finally, a review of global studies on atrial fibrillation (AF) emphasizes a lack of data from outside North America and Europe. This gap is noted especially in understanding AF's epidemiology, risk factors, and management in diverse populations, like those in Asia and the Middle East. Improved knowledge of AF in these regions is deemed necessary due to its increasing prevalence and associated clinical and financial burdens, further highlighting the need for resource reallocation to address global health disparities effectively.

Keywords

catheter-related bloodstream infections

ventilator-associated pneumonia

diagnostic practices

interferon-gamma release assays

tuberculosis testing

atrial fibrillation

global health disparities

antibiotic administration

epidemiology

healthcare workers