Rapid Syndromic Testing Shows Promise in ICU Pneumonia Diagnosis and Antibiotic Stewardship
Pneumonia remains a formidable challenge in the intensive care unit (ICU), often prompting empiric use of broad-spectrum antibiotics. However, recent evidence highlights how integrating rapid syndromic diagnostic tools with antimicrobial stewardship programs (ASPs) may improve pathogen detection and guide more precise antibiotic use.
A single-center study evaluating the Unyvero Hospitalized Pneumonia (HPN) multiplex PCR panel, recently published in Antibiotics, found that the system demonstrated full agreement with standard cultures in about half the cases, partial agreement in nearly as many, and rare discordance. The panel also identified more pathogens per sample compared to standard culture (1.32 vs 1.1) and returned results within approximately five hours—substantially faster than the 48–72 hours required for traditional methods.
The most commonly detected pathogens included Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Notably, the panel also identified several antimicrobial resistance genes, such as sul1, tem, ndm, and oxa-23, providing valuable resistance data in nearly 90% of tested cases.
In parallel, a systematic review and network meta-analysis of over 25,000 patient encounters, published in Clinical Infectious Diseases, assessed the impact of rapid diagnostic tests (RDTs) and ASPs in managing bloodstream infections. While the study did not focus on pneumonia specifically, its findings are relevant. The analysis revealed that pairing RDTs with stewardship programs reduced mortality compared to conventional blood cultures alone (OR 0.72) and even outperformed stewardship-enhanced conventional diagnostics (OR 0.78). Additionally, this combination accelerated time to optimal therapy by up to 29 hours.
However, these benefits were only observed when stewardship interventions accompanied the diagnostics. RDTs used in isolation did not significantly reduce mortality or hospital length of stay. This underscores the importance of having a stewardship infrastructure in place to interpret and act on rapid test results.
For pneumonia management in ICU settings, the implications are promising. The Unyvero study reported that combining rapid panel data with stewardship feedback led to more appropriate antibiotic adjustments, often initiated more than two days earlier than would have been possible with culture results alone. These interventions also reduced the rate of inappropriate antibiotic use from 44% to 17%.
While encouraging, these findings come with caveats. Syndromic panels may detect both colonizing organisms and true pathogens, which can complicate clinical interpretation, especially in patients with chronic respiratory colonization. Moreover, the cost-effectiveness and operational feasibility of implementing these tests in routine ICU practice depend on local resources and workflows.
Nonetheless, in settings where rapid diagnostics are coupled with well-coordinated stewardship, the approach may offer a meaningful improvement in pneumonia management. As hospitals continue to grapple with multidrug-resistant infections and stewardship pressures, the role of rapid, targeted diagnostics appears to be increasingly valuable—especially when used not as a standalone tool, but as part of a coordinated clinical strategy.
Sources:
Livio Vulpie et al., “Use of Rapid Syndromic Testing with a Multiplex PCR-Based System in the Diagnosis and Management of Pneumonia in ICU Patients—Impact on the Appropriateness of Antibiotic Therapy,” Antibiotics 14, no. 4 (2025): 426, https://doi.org/10.3390/antibiotics14040426.
Anna Maria Peri et al., “Rapid Diagnostic Tests and Antimicrobial Stewardship Programs for the Management of Bloodstream Infection: What Is Their Relative Contribution to Improving Clinical Outcomes? A Systematic Review and Network Meta-analysis,” Clinical Infectious Diseases 79, no. 2 (2024): 502–515, https://doi.org/10.1093/cid/ciae234.