The role of syndromic testing in pneumonia diagnosis: a comparison with culture methods

Introduction: Pneumonia is an infection in the pulmonary tissue that is caused by bacteria, viruses, fungi, or parasites. Based on Indonesian Health Survey data for 2023, the prevalence of pneumonia was 10.8%. The rapid detection of pathogens accompanied by their antibiotic sensitivity pattern is crucial to obtain relevant outcomes. The gold standard test by bacterial culture needs approximately 72 hours. In order to speed this up, the PCR-based test was developed, such as syndromic testing. Methodology: The present study was a retrospective study conducted from May 2021 to July 2024, using total sampling, on BAL and sputum specimens, with as inclusion criteria of patients aged ≥ 18 years diagnosed with pneumonia on the basis of bacterial culture and the pneumonia panel test. Results: A total of 147 specimens were collected, with a 66.7% predominance of males and a mean age of 67.24 ± 18.23 years. There was 72.11% correspondence between the two tests, with the proportion of pathogens being 67.35% from the pneumonia panel test and 55.1% from culture. The distribution of pathogens in both tests was dominated by K. pneumoniae, whereas the most frequent antibiotic resistance genes were CTX-M and IMP. The antibiotics that may still be of choice for the therapy of Gram-negative bacteria are tigecycline and amikacin, while for P. aeruginosa, the antibiotic of choice is piperacillin-tazobactam. Conclusions: The pneumonia panel test provides higher positivity rates, faster results, and detects resistance genes, but lacks coverage for fungi and S. maltophilia.