Reviewed by Shipra Gupta, MD, MS, Children’s Hospital at Montefiore
Bottom line: RT- PCR testing in tracheal aspirates is a promising antimicrobial stewardship tool but the current panel offers lower specificity and does not include certain pathogens.
Osborne and colleagues compared tracheal aspirate multiplex reverse transcriptase polymerase chain reaction (RT-PCR) with traditional bacterial culture for diagnosing bacterial lower respiratory tract infections in mechanically ventilated children. They found RT-PCR to have improved detection rates of on-panel bacteria (73.2% vs. 55.3% at intubation and 68.9% vs. 58.1% for VAP). With high sensitivity (93.9%) and negative predictive value (92.1%), RT-PCR demonstrated potential in rapidly identifying pathogens, even in patients already on antibiotics. However, it had lower specificity (43.2%) and discrepancies between RT-PCR and culture were noted in a few cases. Despite its promising role in influencing antibiotic decisions and antimicrobial stewardship, the study’s limitations, such as missing certain pathogens like Stenotrophomonas, suggest RT-PCR should be used alongside traditional culture methods for more comprehensive diagnosis.
Reference:
Osborne, C. M, et al. Multiplex Polymerase Chain Reaction Versus Standard Bacterial Culture in Critically Ill Children With Suspected Pneumonia. PIDJ. 2025. https://doi.org/10.1097/INF.0000000000004570
