Rapid diagnosis of community aquired pneumonia

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Department of Clinical Microbiology, Umeå University, and
Infectious diseases, Norrlands University hospital

Introduction
Community acquired pneumonia is a major cause of morbidity and mortality. Empiric antibiotic treatment is given based on clinical symptoms, x-ray and laboratory findings. Clinical scoring systems, like PSI and CRB-65, aid the physician in decisions regarding treatment in hospital or outpatient treatment, level of hospital supervision and treatment. Traditional diagnostic methods such as serology and cultivation of specific pathogens are not rapid, nor sensitive enough to meet the increasing demand for etiologic diagnostics. Even though initial treatment usually is effective, there is an unmet need for prognostic and diagnostic markers for pneumonia, which is increasing with the spread of antibiotic resistance.

Aims
To develop more sensitive, specific and rapid diagnostic tools to be useful in the clinical setting (quantitative PCR, microsphere-based multiplexed assays, metabolomics).
To explore the possibility of increasing the prognostic value of biomarkers, though multivariate analysis.

PCR
We use quantitative, real-time PCR to develop a new diagnostic assay for 16 viral and bacterial infectious agents. Our aim is to include the assay as a rapid method for etiologic diagnosis for patients with suspected pneumonia. For optimal efficiency, we use a multiplex approach. Up to three agents are analyzed in the same well of the PCR plate. All 16 agents can therefore be analyzed at the same time.

RAPID
The clinical study RAPID is performed at the Clinic of Infectious diseases Norrlands University hospital since October 2010. Patients with suspected CAP (community acquired pneumonia) are enrolled.