CHEST Guidelines-Testing-for-Respiratory-Viruses-in-Adults-With-Sev

Testing-for-Respiratory-Viruses-in-Adults-With-Sev

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The document reviews the advancements and implications of respiratory viral testing in adults with severe lower respiratory tract infections (LRTIs), emphasizing the shift from traditional culture-based methods to rapid, multiplex high-throughput systems. LRTIs such as pneumonia and bronchitis are significant causes of morbidity and mortality, with viruses being frequently identified pathogens. This has led to discussions on whether routine viral testing might improve patient outcomes by aiding in rapid diagnosis and enhancing antimicrobial stewardship.<br /><br />Recent epidemiological changes have emphasized viruses over bacteria as common severe LRTI agents, prompting reassessment of viral testing's role. New diagnostic technologies allow the accurate detection of respiratory viruses, but their clinical significance and utility in routine care require analysis.<br /><br />Several diagnostic techniques, including serologic testing, culture methods, rapid antigen detection, and advanced molecular assays (like PCR and RT-PCR), are discussed. Each has specific strengths and limitations, making it crucial for clinicians to choose the appropriate test based on clinical context.<br /><br />The document explores whether viral testing improves patient management by reducing unnecessary antibiotic use or facilitating targeted antiviral therapy. While small studies in children showed promising results, outcomes in adults have been inconsistent. Some studies indicate that even with confirmed viral infections, antibiotics continue to be prescribed, often due to concerns over bacterial coinfections and diagnostic uncertainty. Trials like the ResPOC study did not show a significant reduction in antibiotic use, though they highlighted potential areas of benefit such as quicker isolation and appropriate antiviral therapy.<br /><br />The document stresses the importance of embedding viral testing in comprehensive antimicrobial stewardship programs and suggests utilizing it alongside biomarkers like procalcitonin (PCT) to improve clinical decision-making. Future research should address the high percentage of cases with unidentified pathogens and the overall cost-effectiveness of incorporating advanced testing into routine care.

Keywords

respiratory viral testing

lower respiratory tract infections

LRTIs

rapid diagnosis

antimicrobial stewardship

multiplex high-throughput systems

molecular assays

antiviral therapy

procalcitonin

diagnostic uncertainty