Clinical Study
Rapid Molecular Diagnostics for Lower Respiratory Tract Infections
Barbara D. Alexander, MD, MHS; Kimberly E. Hanson, MD, MHS; Adriana E. Rosato, PhD; David B. Nash, MD; Maren S. Fragala, PhD; Steven E. Goldberg, MD, MBA • April 28, 2025
Key Summary of Published Article – Rapid Molecular Diagnostics for Lower Respiratory Tract Infections in Urgent Care: Filling a Selective Gap – Journal of Urgent Care Medicine
A new manuscript published in Journal of Urgent Care Medicine, co-authored by esteemed experts and advisory board members, describes how molecular diagnostics for lower respiratory tract infections fills a selective gap in urgent care medicine.
Authors include Barbara D. Alexander, MD, MHS; Kimberly E. Hanson, MD, MHS; Adriana E. Rosato, PhD; David B. Nash, MD; Maren S. Fragala, PhD; Steve Goldberg, MD, MBA
The Problem
Community-acquired pneumonia is a leading cause of infectious disease-related hospitalization and death in the United States. While current guidelines recommend treatment with ‘empiric’ therapy based on the most likely pathogen, diagnostic uncertainty and error can lead to inappropriate treatments and unnecessary antibiotic prescribing. Non-specific treatment of community acquired pneumonia presents a clinical challenge for urgent care physicians where reduced diagnostic uncertainty could lead to more targeted care.
The Solution
Diagnostic uncertainty can be reduced through innovations in molecular diagnostics. This has been shown in inpatient and emergency department settings with syndromic multiplex polymerase chain reaction-based testing. Syndromic multiplex panels enable physicians to order tests by ‘syndrome’ (for example, upper or lower respiratory tract symptoms) in patients for whom empiric decision-making or available point-of-care testing have proved insufficient. These tests offer high diagnostic accuracy for detecting both viral and bacterial respiratory pathogens with sensitivity and specificity above 90% for most pathogens. The detection of multiple pathogens simultaneously facilitates early pathogen-directed treatment, reducing unnecessary use of antibiotics, and shortening the length of pneumonia-related hospitalization.
The Manuscript
Use of syndromic multiplex polymerase chain reaction-based testing in urgent care settings could also improve community-acquired pneumonia treatment through early and accurate identification of the infecting pathogen. Patients with potential lower respiratory tract infections who could benefit may include those with worsening symptoms, recent antibiotic treatment, comorbidities, risk for polymicrobial pathogens, or severity in clinical presentation. In these cases, early and accurate detection of the infecting pathogen could inform treatment and help reduce unnecessary or inappropriate antibiotic use. To prevent overtreatment, testing is most appropriate for patients with infectious signs and symptoms with panels aligned to those presenting clinical symptoms in order to increase the likelihood that the organisms detected are pathogenic.
Conclusion
Molecular-based tests can improve diagnostic accuracy for lower respiratory tract infections such as community-acquired pneumonia in urgent care settings. By offering faster, more sensitive, diagnostics which can guide effective pathogen-directed therapy, they are well suited to provide positive clinical impact. Today, urgent care clinicians can reduce diagnostic error and uncertainty by incorporating these tests into patient care algorithms for undifferentiated respiratory infections. As more studies emerge, the value of integrating multiplex syndromic molecular diagnostics into routine outpatient clinical practice may be demonstrated and reimbursement policies may align.
Related Articles and White papers
Barbara D. Alexander, MD, MHS; Kimberly E. Hanson, MD, MHS; Adriana E. Rosato, PhD; David B. Nash, MD; Maren S. Fragala, PhD; Steven E. Goldberg, MD, MBA • April 28, 2025
Key Summary of Published Article – Rapid Molecular Diagnostics for Lower Respiratory Tract Infections in Urgent Care: Filling a Selective Gap – Journal of Urgent Care Medicine
A new manuscript published in Journal of Urgent Care Medicine, co-authored by esteemed experts and advisory board members, describes how molecular diagnostics for lower respiratory tract infections fills a selective gap in urgent care medicine.
Authors include Barbara D. Alexander, MD, MHS; Kimberly E. Hanson, MD, MHS; Adriana E. Rosato, PhD; David B. Nash, MD; Maren S. Fragala, PhD; Steve Goldberg, MD, MBA
The Problem
Community-acquired pneumonia is a leading cause of infectious disease-related hospitalization and death in the United States. While current guidelines recommend treatment with ‘empiric’ therapy based on the most likely pathogen, diagnostic uncertainty and error can lead to inappropriate treatments and unnecessary antibiotic prescribing. Non-specific treatment of community acquired pneumonia presents a clinical challenge for urgent care physicians where reduced diagnostic uncertainty could lead to more targeted care.
The Solution
Diagnostic uncertainty can be reduced through innovations in molecular diagnostics. This has been shown in inpatient and emergency department settings with syndromic multiplex polymerase chain reaction-based testing. Syndromic multiplex panels enable physicians to order tests by ‘syndrome’ (for example, upper or lower respiratory tract symptoms) in patients for whom empiric decision-making or available point-of-care testing have proved insufficient. These tests offer high diagnostic accuracy for detecting both viral and bacterial respiratory pathogens with sensitivity and specificity above 90% for most pathogens. The detection of multiple pathogens simultaneously facilitates early pathogen-directed treatment, reducing unnecessary use of antibiotics, and shortening the length of pneumonia-related hospitalization.
The Manuscript
Use of syndromic multiplex polymerase chain reaction-based testing in urgent care settings could also improve community-acquired pneumonia treatment through early and accurate identification of the infecting pathogen. Patients with potential lower respiratory tract infections who could benefit may include those with worsening symptoms, recent antibiotic treatment, comorbidities, risk for polymicrobial pathogens, or severity in clinical presentation. In these cases, early and accurate detection of the infecting pathogen could inform treatment and help reduce unnecessary or inappropriate antibiotic use. To prevent overtreatment, testing is most appropriate for patients with infectious signs and symptoms with panels aligned to those presenting clinical symptoms in order to increase the likelihood that the organisms detected are pathogenic.
Conclusion
Molecular-based tests can improve diagnostic accuracy for lower respiratory tract infections such as community-acquired pneumonia in urgent care settings. By offering faster, more sensitive, diagnostics which can guide effective pathogen-directed therapy, they are well suited to provide positive clinical impact. Today, urgent care clinicians can reduce diagnostic error and uncertainty by incorporating these tests into patient care algorithms for undifferentiated respiratory infections. As more studies emerge, the value of integrating multiplex syndromic molecular diagnostics into routine outpatient clinical practice may be demonstrated and reimbursement policies may align.
