Rapid, season-specific PCR testing versus traditional diagnostics for pneumonia in the emergency department

Abstract

Background: Traditional culture-based diagnostics for emergency-department (ED) pneumonia are slow and season-agnostic, delaying targeted therapy. We evaluated whether season-tailored multiplex PCR panels accelerate pathogen identification and improve antibiotic stewardship.

Methods: In a single-center, prospective study, adults with radiographically confirmed pneumonia were enrolled consecutively and allocated by a rotating week-on/week-off schedule to either a seasonal PCR panel or conventional diagnostics. Primary outcomes were (i) time to final pathogen report and (ii) diagnostic yield (≥ 1 pathogen detected). Secondary outcomes included empiric-antibiotic appropriateness within 24 h, regimen changes ≤ 72 h, antibiotic duration, length of stay (LOS) and 30-day mortality.

Results: Among 282 analyzable patients (spring = 140; autumn-winter = 142), PCR slashed turnaround time from 48 h to 12 h in spring and from 50 h to 14 h in autumn-winter (median difference - 36 h, 95% CI: - 42 to - 30; p < 0.001). Diagnostic yield rose from 61.6 to 80.6% in spring and from 56.8 to 80.0% in winter (risk differences 19.0 pp and 22.3 pp, respectively; both p < 0.01). In the winter cohort, guideline-concordant empiric therapy increased (78.7% vs. 64.9%; +13.8 pp) and antibiotic changes ≤ 72 h fell (14.7% vs. 28.4%; - 13.7 pp). Mean antibiotic courses shortened by 1.5-1.7 days across seasons, while LOS showed a non-significant 1-2-day reduction. Thirty-day mortality did not differ. Effects were consistent in older adults (≥ 65 y) and patients with COPD.

Conclusions: Locally adapted, season-specific multiplex PCR panels deliver near-four-fold faster, higher-yield pathogen detection and support measurable stewardship gains without compromising safety. Implementation in other settings should consider local pathogen seasonality, workflow, and cost structures.

Keywords: Diagnostic accuracy; Emergency department; PCR test panel; Pneumonia diagnosis; Seasonal infections.

Fig. 1

Flowchart for patient screening, eligibility, allocation. Of 356 adults screened, 304 fulfilled inclusion criteria. Ten declined consents, and 12 were excluded after enrolment (non-infectious infiltrate = 5; imaging reinterpretation = 4; repeat ED visit within 30 days = 3). The remaining 282 participants constituted the ITT population. They were split a-priori into a spring cohort (n = 140) and an autumn–winter cohort (n = 142); each cohort was allocated by rotating-week schedule to the season-tailored multiplex PCR panel or to conventional diagnostics. Final numbers analyzed by arm are shown within each box