What is the purpose of a Bacterial Respiratory Panel (BRP)?

From the Guidelines

The use of a bacterial respiratory panel is recommended for patients with suspected community-acquired pneumonia, as it can lead to modification of antimicrobial treatment and improve patient outcomes, as supported by the American Thoracic Society clinical practice guideline 1.

Benefits of Bacterial Respiratory Panel

The bacterial respiratory panel is a valuable diagnostic tool that can detect multiple bacterial pathogens causing respiratory infections from a single sample. This panel uses molecular techniques like PCR to identify common bacterial respiratory pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis. The test provides results within hours, allowing for faster diagnosis and appropriate antibiotic selection.

Clinical Application

Healthcare providers typically order this test when patients present with symptoms like persistent cough, fever, shortness of breath, or other respiratory symptoms that suggest a bacterial infection. The panel is particularly valuable during cold and flu season when distinguishing between viral and bacterial infections is crucial for proper treatment. It helps avoid unnecessary antibiotic use for viral infections while ensuring prompt treatment for bacterial pathogens.

Evidence-Based Recommendation

According to the American Thoracic Society clinical practice guideline 1, the use of a bacterial respiratory panel can lead to modification of antimicrobial treatment, with studies showing that pathogen identification using multiplex PCR led to changes in antibiotic treatment in 22% of patients. Additionally, PCR for atypical pathogens was associated with any alteration of antibiotic treatment by Hospital Day 3 (OR, 2.6; 95% CI, 1.4–4.9) and an alteration of atypical coverage (OR, 3.1 95% CI, 1.6–6.0) 1.

Key Points

• The bacterial respiratory panel is a diagnostic test that detects multiple bacterial pathogens causing respiratory infections from a single sample.
• The test provides results within hours, allowing for faster diagnosis and appropriate antibiotic selection.
• The panel is particularly valuable during cold and flu season when distinguishing between viral and bacterial infections is crucial for proper treatment.
• The use of a bacterial respiratory panel can lead to modification of antimicrobial treatment and improve patient outcomes, as supported by the American Thoracic Society clinical practice guideline 1.

From the Research

Bacterial Respiratory Panel

• The bacterial respiratory panel is used to diagnose respiratory tract infections, including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) 2, 3.
• The choice of empiric antibiotic therapy for these infections depends on the likely etiologies and anticipated resistance patterns, as well as the patient's medical history and current condition 3.
• Studies have shown that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP 2, 4.
• The combination of a third-generation cephalosporin and a macrolide is also effective in treating hospitalized patients with moderate to severe CAP, and may be preferred over fluoroquinolones as first-line therapy to minimize the development of multiresistant nosocomial Gram-negative bacilli 5.
• The timing of antibiotic therapy is critical in the treatment of life-threatening infections, including sepsis and septic shock, and delays in administration can result in increased mortality 6.
• Aggressive antimicrobial de-escalation based on microbiology results is necessary to counterbalance the pressures of early broad-spectrum antibiotic therapy and minimize the unnecessary use of antibiotics 6.

Antibiotic Treatment Options

• Levofloxacin is a fluoroquinolone antibiotic that is active against a wide range of Gram-negative, Gram-positive, and atypical pathogens, including Streptococcus pneumoniae 2.
• Ceftriaxone is a third-generation cephalosporin antibiotic that is effective against a variety of bacterial infections, including CAP 5, 4.
• Azithromycin is a macrolide antibiotic that is often used in combination with ceftriaxone to treat CAP 5, 4.
• The choice of antibiotic therapy should be based on the patient's medical history, current condition, and the results of microbiology tests, as well as local resistance patterns and treatment guidelines 3, 6.