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Types of Syndromic testing

In this video, Professor Matteo Bassetti discusses some syndromic testing panels.
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Regarding the type of syndromic testing that should be used in improving antimicrobial stewardship approaches, we have to differentiate, first of all, between conventional diagnostic tests - that are represented mainly by the bacterial cultures or by the 16S rRNA - and then for the new tests that we can call tests for the rapid identification of bugs. Syndromic test means that we can use this type of test based on the different tissue material. We have the classical tests that are used for bloodstream bacterial pathogens. And obviously, we have the PNA-FISH, the QuickFISH, the Gene Xpert, the multiple PCR. And then we have the FilmArray and the Light Cyler.
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So the FilmArray is probably the most interesting test to be used for the syndromic approach. So probably the best test for syndromic approach is represented by the BioFire Pneumonia plus, in which we have several bugs that are identified by the test. We have bacteria. And in general, we have the gram negatives plus gram positives - all the classical bacteria that sustain pneumonia. And we have Pseudomonas, and we have Klebsiella. We have all the other Enterobacteriales, Acinetobacter, Staphylococcus aureus, but also Streptococcus pneumoniae and Streptococcus pyogenes.
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But we have also, at the same time, typical bacterial: Legionella, Mycoplasma, Chlamydia, and also viruses. Viruses include influenza A, influenza B, the RSV, and many other respiratory viruses, including coronavirus, adenovirus, and parainfluenza, and also the MERS-CoV. And then we have also the possibility to determine the antimicrobial resistant genes, in which we have the mecA (typical for MRSA), the KPC, the NDM, the Oxa48, the CTX-M, the VIM, and IMP. So this is going to be a very interesting test, because using this test, we are able to de-escalate the treatment or escalate the treatment. So we can do the rapid test, and can start an empiric antibiotic therapy.
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And then based on the results that are available in a few hours, we can eventually fine-tune our treatment in order to escalate if it was not adequate treatment that we started at the beginning, or eventually, de-escalate if we start, for instance, a combination therapy. So when we look at the data regarding the role of the BioFIre Pneumonia Panel, there is a lot of truth about the fact that this kind of test is able to reduce significantly the number of antibiotics used. And obviously this is important in terms of an antimicrobial stewardship approach. And obviously at the end, we have a more appropriate use of antibiotics, and at the same time, a reduction in resistance rates.
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So I believe that this is going to be an interesting test to be implemented. Also at the time of COVID-19, now, we have the BioFire RP2.1 plus that includes not only the bugs that I mentioned before, but we have also the spike protein element and the membrane protien typical of SARS-CoV-2, so in this way, we have the majority of the virus that are, in general, present at this time. So we have the bacterial - represented by Chlamydia, Mycoplasma - but also we have the majority of, if not all, the virus. And obviously, this test should be used in order to exclude SARS-CoV-2 or other viruses.

As mentioned in the previous week of the course, syndromic testing can rapidly detect multiple pathogens that cause overlapping signs and symptoms. Even though these often come in the form of panels with multiple likely microbial targets, it is not feasible to have every microbe target possible on a single panel. In this video, Professor Matteo Bassetti discusses some available syndromic testing panels.

Different rapid syndromic panels are available for different clinical syndromes. For instance, there are panels that focus on different infectious illnesses such as:

• Bloodstream infections

• Central nervous system (CNS) infections

• Upper respiratory infections

• Lower respiratory infections

• Gastrointestinal infections

• Joint infections

These panels contain targets of the main microorganisms responsible for these illnesses and can thus identify the causative pathogen(s), and resistance genes, quickly. The instrument, time to results, and targets of these panels will vary across manufacturers. Some specific examples are provided in the downloads section below.

References cited in the video have been provided as links in the see also section below.

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Syndromic Testing and Antimicrobial Stewardship

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