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. 2020 Dec 17;71(10):2744-2751.
doi: 10.1093/cid/ciaa508.

Molecular Testing for Acute Respiratory Tract Infections: Clinical and Diagnostic Recommendations From the IDSA's Diagnostics Committee

Kimberly E Hanson  1   2 , Marwan M Azar  3 , Ritu Banerjee  4 , Andrew Chou  5 , Robert C Colgrove  6 , Christine C Ginocchio  7   8 , Mary K Hayden  9   10 , Mark Holodiny  11   12 , Seema Jain  13 , Sophia Koo  14 , Jaclyn Levy  15 , Tristan T Timbrook  16   17 , Angela M Caliendo  18
Affiliations

Molecular Testing for Acute Respiratory Tract Infections: Clinical and Diagnostic Recommendations From the IDSA's Diagnostics Committee

Kimberly E Hanson et al. Clin Infect Dis. .

Abstract

The clinical signs and symptoms of acute respiratory tract infections (RTIs) are not pathogen specific. Highly sensitive and specific nucleic acid amplification tests have become the diagnostic reference standard for viruses, and translation of bacterial assays from basic research to routine clinical practice represents an exciting advance in respiratory medicine. Most recently, molecular diagnostics have played an essential role in the global health response to the novel coronavirus pandemic. How best to use newer molecular tests for RTI in combination with clinical judgment and traditional methods can be bewildering given the plethora of available assays and rapidly evolving technologies. Here, we summarize the current state of the art with respect to the diagnosis of viral and bacterial RTIs, provide a practical framework for diagnostic decision making using selected patient-centered vignettes, and make recommendations for future studies to advance the field.

Keywords: molecular diagnostics; respiratory viruses; utilization.

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Figures

Figure 1.
Figure 1.
Conceptual hierarchical model of efficacy for molecular diagnostics. Adapted with permission from Fryback and Thornbury [15].
Figure 2.
Figure 2.
The importance of pretest probability. The predictive value of rapid molecular testing is displayed over the course of a typical influenza season given the published sensitivity and specificity of current influenza molecular assays. Abbreviations: ILI, influenza-like illness; NPV, negative-predictive value; PPV, positive-predictive value.
See this image and copyright information in PMC

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