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Cited by 20Bacterial Identification and Susceptibility TestingPneumonia and Respiratory InfectionsNosocomial Infections in ICU

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Impact of syndromic molecular diagnostics on antimicrobial adequacy and time to therapy in critically ill patients with pneumonia: a systematic review and meta-analysis of randomized trials

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de Albuquerque Pessoa dos Santos, Yuri, Tomazini, Bruno Martins, dos Santos, Maurício Henrique Claro, de Queiroz, Eduardo Lyra, Pastore Júnior, Laerte, Costa, Eduardo Leite Vieira, da Silva Ramos, Fernando José·2025·Critical Care
DOI 10.1186/s13054-025-05623-0PMC PMC12374470

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Abstract

BACKGROUND: Pneumonia is a leading cause of ICU admission and mortality, requiring prompt and adequate antimicrobial therapy to improve outcomes. Conventional cultures are slow and often insensitive, delaying targeted treatment. Syndromic PCR panels offer rapid identification of pathogens and resistance genes directly from respiratory samples, potentially improving early antibiotic optimization. However, the true clinical benefit of these diagnostics in critically ill patients remains uncertain. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PCR-based molecular diagnostics with standard culture techniques in predominantly adult ICU patients with severe community-acquired, hospital-acquired, or ventilator-associated pneumonia. Literature searches were performed in PubMed, Embase, and Cochrane CENTRAL from inception to July 16, 2025. The primary outcome was in-hospital mortality. Secondary outcomes included adequacy of initial antimicrobial therapy and time to effective antibiotic administration. Data were synthesized using random-effects models. RESULTS: We included five randomized controlled trials comprising 2,466 patients. Syndromic PCR testing did not significantly reduce in-hospital mortality, the primary outcome (RR 1.04; 95% CI: 0.90–1.21; p = 0.57; I² = 0%). However, PCR testing was associated with a higher rate of adequate initial antimicrobial therapy (RR 1.82; 95% CI: 1.10–3.00; p = 0.02; I² = 97%) and a reduction in time to effective antibiotic administration (mean difference − 27.98 h; 95% CI: − 46.07 to − 9.89; p = 0.002; I² = 94%). CONCLUSIONS: Syndromic PCR diagnostics did not reduce in-hospital mortality in critically ill patients with pneumonia but were associated with improved adequacy of initial antimicrobial therapy and faster initiation of effective treatment. These findings support their role as a complementary tool in ICU-based antimicrobial stewardship. TRIAL REGISTRATION : PROSPERO CRD420251006301.

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Crossref · 10.1186/s13054-025-05623-0

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Figures

Fig. 1 Prisma flow diagram of study screening and selection
Fig. 1 Prisma flow diagram of study screening and selectionCC BY-NC-ND · PubMed Central
Fig. 2 Forest plot of In-hospital mortality. There was no statistically significant difference in in-hospital mortality between patients evaluated with syndromic PCR panels and those assessed by conventional microbiology (risk ratio 1.04; 95% confidence interval: 0.90–1.21; p = 0.57; I² = 0%)
Fig. 2 Forest plot of In-hospital mortality. There was no statistically significant difference in in-hospital mortality between patients evaluated with syndromic PCR panels and those assessed by conventional microbiology (risk ratio 1.04; 95% confidence interval: 0.90–1.21; p = 0.57; I² = 0%)CC BY-NC-ND · PubMed Central
Fig. 3 Forest plot of adequacy of initial antimicrobial therapy. Use of syndromic molecular panels (PCR panel) was associated with significantly higher rates of adequate initial antimicrobial therapy compared to conventional microbiology (risk ratio 1.78; 95% confidence interval: 1.23–2.57; p = 0.002; I² = 95%)
Fig. 3 Forest plot of adequacy of initial antimicrobial therapy. Use of syndromic molecular panels (PCR panel) was associated with significantly higher rates of adequate initial antimicrobial therapy compared to conventional microbiology (risk ratio 1.78; 95% confidence interval: 1.23–2.57; p = 0.002; I² = 95%)CC BY-NC-ND · PubMed Central
Fig. 4 Forest Plot of Time to Effective Antimicrobial Therapy. Syndromic molecular panel (PCR Panel) testing significantly reduced the time to effective antibiotic administration compared to conventional microbiology (mean difference − 28.03 h; 95% confidence interval: −47.49 to − 8.58; p = 0.005; I² = 95%)
Fig. 4 Forest Plot of Time to Effective Antimicrobial Therapy. Syndromic molecular panel (PCR Panel) testing significantly reduced the time to effective antibiotic administration compared to conventional microbiology (mean difference − 28.03 h; 95% confidence interval: −47.49 to − 8.58; p = 0.005; I² = 95%)CC BY-NC-ND · PubMed Central

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Citations

Cites

Research works printed but not linked: 24

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Metadata

Authors
de Albuquerque Pessoa dos Santos, Y., Tomazini, B. M., dos Santos, M. H. C., de Queiroz, E. L., Pastore Júnior, L., Costa, E. L. V., & da Silva Ramos, F. J.
Affiliations
  • Hospital do Coração (BR)
  • Hospital Sírio-Libanês (BR)
  • Universidade de São Paulo (BR)
Corresponding author
dos Santos, Maurício Henrique Claro
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2025-08-22
Volume
29
Issue
1
Pages
379-379
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-025-05623-0
PMC
PMC12374470
OpenAlex
W4413412404
Cited by
20
References
4
Citations by year
2026: 20
FWCI
2.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by-nc-nd)
  • Research Square (acceptedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Microbiology (medical) › Bacterial Identification and Susceptibility Testing
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
molecular diagnosis, pneumonia, critically ill patients, in-hospital mortality, antimicrobial stewardship, ventilator-associated pneumonia, nosocomial pneumonia, community-acquired pneumonia, pathogen identification, antimicrobial resistance genes, cultural comparison
MeSH terms
Anti-Infective Agents, Anti-Bacterial Agents, Humans, Pneumonia, Randomized Controlled Trials as Topic, Critical Illness, Hospital Mortality, Molecular Diagnostic Techniques, Time-to-Treatment

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