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Molecular Diagnostics, Antimicrobial Resistance Patterns, and Clinical Outcomes in Hospitalized Pneumonia Patients: A
Ahmad R Alsayed1, Mamoon Zihlif2, Osama Mustafa Abuata3
1Department of Clinical Pharmacy and Therapeutics, Applied Science Private University (ASU), Amman, Jordan.
Purpose:
Pneumonia is still a leading cause of morbidity and death globally, with a significant percentage of cases having an unknown aetiology, and management becoming more difficult due to growing antimicrobial resistance (AMR). This study assessed clinical outcomes, antimicrobial susceptibility patterns, and pathogen detection using both conventional and molecular techniques in hospitalized pneumonia patients in Jordan.
Patients And Methods:
111 adults (≥18 years) who were admitted to a tertiary private hospital in Amman between May 2021 and January 2022 with either hospital-acquired (HAP) or community-acquired pneumonia (CAP) were included in this prospective study. Multiplex real-time PCR and conventional culture were performed on lower respiratory tract samples (FTD Respiratory Pathogens 33). Data on outcomes, microbiology, antimicrobial susceptibility, clinical, and demographics were gathered. McNemar's test was used to compare diagnostic performance, and logistic regression and chi-square analyses were used to evaluate the relationships between outcomes and adherence to guidelines.
Results:
The average age was 64.0±20.6 years, and 58.6% of the population was male. 78.4% of cases were CAP. PCR detected pathogens in 74.8% of patients, whereas culture detected them in 57.7% (p<0.001). PCR showed a higher false-positive rate but a significantly higher sensitivity than culture (96.9% vs 86.3%, p=0.039). In 36.9% of cases, bacterial-viral co-infections were found. The overall death rate was 27.0%. Although not an independent predictor in logistic regression, non-guideline-concordant antibiotic therapy was substantially associated with mortality (p=0.023). High ampicillin resistance and notable trends in resistance to specific broad-spectrum agents were among the notable variations in AMR patterns observed.
Conclusion:
Multiplex PCR reveals complex co-infection patterns in pneumonia and greatly enhances pathogen detection when compared to culture. Antimicrobial stewardship initiatives that incorporate molecular diagnostics may improve targeted treatment. To address changing AMR patterns in Jordan, national guidelines that include molecular testing are necessary.
Insights
Multiplex PCR significantly improves pneumonia pathogen detection compared to traditional culture, revealing complex co-infections. This highlights the need for molecular diagnostics in Jordan to combat antimicrobial resistance and guide treatment.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Pneumonia remains a major global cause of illness and death.
- Rising antimicrobial resistance (AMR) complicates pneumonia management.
- A significant proportion of pneumonia cases have an unknown cause.
Purpose of the Study:
- To evaluate clinical outcomes in hospitalized pneumonia patients in Jordan.
- To analyze antimicrobial susceptibility patterns.
- To compare pathogen detection rates between conventional and molecular methods.
Main Methods:
- A prospective study of 111 adult pneumonia patients (hospital-acquired and community-acquired) in Amman.
- Lower respiratory tract samples analyzed using multiplex real-time PCR and conventional culture.
- Clinical data, microbiology, and antimicrobial susceptibility were collected and analyzed.
Main Results:
- PCR detected pathogens in 74.8% of patients, significantly higher than culture (57.7%).
- PCR demonstrated higher sensitivity (96.9%) than culture (86.3%).
- Bacterial-viral co-infections were identified in 36.9% of cases; the overall mortality rate was 27.0%.
Conclusions:
- Multiplex PCR offers superior pathogen detection and reveals complex co-infections in pneumonia.
- Integrating molecular diagnostics into antimicrobial stewardship can enhance targeted therapy.
- National guidelines in Jordan should incorporate molecular testing to address evolving AMR patterns.
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