ATS Guideline Addresses Testing for Viral Pathogens in CAP

In a clinical practice guideline issued by the American Thoracic Society and published in the May 1 issue of the American Journal of Respiratory and Critical Care Medicine, nucleic acid-based viral diagnostics are suggested for hospitalized patients with suspected community-acquired pneumonia (CAP) but only for patients who have severe disease or are immunocompromised.

Scott E. Evans, M.D., from Yale University in New Haven, Connecticut, and colleagues examined the literature to develop recommendations regarding whether routine diagnostics should include nucleic acid-based testing of respiratory samples for viral pathogens other than influenza in adults with suspected CAP.

Because of the risk for bias and imprecision, the evidence addressing this topic was generally adjudicated to be of very low quality. There was little direct evidence to support a role for routine nucleic acid-based testing of respiratory samples for improving critical outcomes; these outcomes included overall survival or patterns of antibiotic use. Consequently, the authors suggested not performing routine nucleic acid-based testing of respiratory samples for viral pathogens other than influenza in outpatients with suspected CAP. Nucleic acid-based testing of respiratory samples for viral pathogens other than influenza is suggested for hospitalized patients with suspected CAP who have severe CAP or are immunocompromised.

"At the time of document development, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was not a recognized CAP-causing pathogen," the authors write. "As such, the systematic literature review did not consider this virus, and no related recommendations are made."

Several authors disclosed financial ties to the biopharmaceutical industry.