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In 2024, respiratory infectious diseases continue to pose a pressing challenge to global public health, mainly due to antibiotic resistance, disease complexity, and widespread transmission, all of which will increase the global disease burden. In addition, the updated bacterial priority pathogens list and the resurgence of certain pathogens have added new layers of complexity to the diagnosis and treatment of respiratory infectious diseases Over the past year, significant progress has been achieved, particularly in rapid diagnostic technologies, the development of innovative anti-infective drugs, and the advancement of vaccines. This article provides an overview of the most important research advances in the field of respirator y infectious diseases.

Background: Pathogenic microorganisms can cause infections, allergies, diarrhoea, tumours, other diseases, and even death. Therefore, the detection of pathogenic microorganisms is important., Methods: In this study, a bioinformatics pipeline was developed. First, a comprehensive and penetrating reference database of nucleic acids from pathogenic microorganisms was constructed, and sequence alignment analysis was performed via nanopore sequencing of metagenomic data collected from 40 patients with lower respiratory tract infection symptoms. The similarity, abundance, and matching length of the sequences were integrated to obtain a comprehensive parameter, all_ratio, which can be used to identify pathogenic microorganisms effectively., Results: Compared with two previous methods, i.e., pathogen identification via microbiological culture or a previously reported metagenomic pipeline, pathogens were detected in 23 out of the 40 samples using our method, with the same results as those of the previous two methods. In five samples, pathogens such as Streptococcus pneumoniae and Granulicatella adiacens that had not been detected via the previous two methods were detected using our method. Pathogens such as Streptococcus pneumoniae and Neisseria flavescens were detected in 12 samples via our method, in contrast to the results of the previous two methods. Therefore, it is presumed that the individuals from whom these samples were obtained may have been infected with two or more pathogenic microorganisms., Conclusions: This study shows that our method can efficiently identify pathogenic microorganisms and even detect pathogenic microorganisms in samples that cannot be detected via other methods, thus supplementing existing methods., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Traditional detection methods face challenges in meeting the diverse clinical needs for diagnosing both lung cancer and infections within a single test. Onco-mNGS has emerged as a promising solution capable of accurately identifying infectious pathogens and tumors simultaneously. However, critical evidence is still lacking regarding its diagnostic performance in distinguishing between pulmonary infections, tumors, and non-infectious, non-tumor conditions in real clinical settings., Methods: In this study, data were gathered from 223 participants presenting symptoms of lung infection or tumor who underwent Onco-mNGS testing. Patients were categorized into four groups based on clinical diagnoses: infection, tumor, tumor with infection, and non-infection-non-tumor. Comparisons were made across different groups, subtypes, and stages of lung cancer regarding copy number variation (CNV) patterns, microbiome compositions, and clinical detection indices., Results: Compared to conventional infection testing methods, Onco-mNGS demonstrates superior infection detection performance, boasting a sensitivity of 81.82%, specificity of 72.55%, and an overall accuracy of 77.58%. In lung cancer diagnosis, Onco-mNGS showcases excellent diagnostic capabilities with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value reaching 88.46%, 100%, 91.41%, 100%, and 90.98%, respectively. In bronchoalveolar lavage fluid (BALF) samples, these values stand at 87.5%, 100%, 94.74%, 100%, and 91.67%, respectively. Notably, more abundant CNV mutation types and higher mutation rates were observed in adenocarcinoma (ADC) compared to squamous cell carcinoma (SCC). Concurrently, onco-mNGS data revealed specific enrichment of Capnocytophaga sputigeria in the ADC group and Candida parapsilosis in the SCC group. These species exhibited significant correlations with C reaction protein (CRP) and CA153 values. Furthermore, Haemophilus influenzae was enriched in the early-stage SCC group and significantly associated with CRP values., Conclusions: Onco-mNGS has exhibited exceptional efficiencies in the detection and differentiation of infection and lung cancer. This study provides a novel technological option for achieving single-step precise and swift detection of lung cancer., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of First Affiliated Hospital, Guangzhou Medical University with approval number of 2022No.51, and all data were anonymized prior to analysis. The study was conducted in accordance with the Declaration of Helsinki and the study data were obtained from Department of Respiratory, First Affiliated Hospital, Guangzhou Medical University. Informed consent was obtained from all participants or their legal guardians. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

This study investigates the prevalence and clinical characteristics of respiratory viruses among patients with acute respiratory illness (ARI) in a low-resource setting, using a rapid antigen test as a point-of-care test (POCT). We included 343 patients presenting with ARI symptoms at an outpatient pulmonary clinic from December 2023 to April 2024. Nasopharyngeal swabs were tested for SARS-CoV-2, influenza A/B, respiratory syncytial virus, and adenovirus using POCT. The overall prevalence of respiratory viruses was 21.2 %, with influenza A being the most common (11.4 %). Shorter duration of symptoms and lower lymphocyte counts were associated with higher influenza positivity. Patients who tested positive for influenza received significantly more antiviral therapy (98.1 % vs. 39.4 %, p<0.001) and less antibiotic therapy (1.9 % vs. 28.5 %, p<0.001) compared to those who tested negative. The study highlights the utility of rapid antigen testing in enhancing antiviral and antibiotic stewardship, thereby improving clinical decision-making and patient outcomes in resource-limited settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Current diagnostic methods of lower respiratory tract infections (LRTIs) often lack specificity, underscoring the necessity for advanced technologies such as metagenomic next-generation sequencing (mNGS)., Methods: This retrospective study compared bronchoalveolar lavage fluid (BALF) analysis using mNGS and conventional microbiological tests (CMT) to evaluate their effectiveness in pathogen identification and alignment with clinical diagnoses., Results: In this study involving 369 patients suspected of LTRIs, mNGS identified pathogens in 342 cases (92.7%), showing superior diagnostic performance compared to CMT (58.8%). The positive agreement and negative agreement rates of mNGS were 92.7% and 96.3%, respectively, both significantly higher than those of CMT (both p<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of mNGS were significantly higher than those of CMT, with values of 99.7% vs. 57.1%, 68.4% vs. 26.3%, 96.5% vs. 87.1%, and 96.3% vs. 6.3%, respectively (all p<0.001). Pathogen detection rates among the patients showed that 89.7% had evidence of LRTIs, with bacterial infections (20.1%), mycoplasma (13.6%), mycobacterium (4.3%), fungal (4.1%), viral (3.3%), and mixed infections (44.4%) being the most common. Furthermore, the study also differentiated the distribution of pathogens between adults and pediatric patients, and assessed the impact of pathogen types on severe outcomes using multivariate logistic regression, revealing that viral and fungal infections were more likely associated with severe symptoms, whereas mycoplasma infections typically presented with milder symptoms., Conclusions: BALF mNGS proves effective for rapid, comprehensive pathogen detection in LRTIs, warranting its early use for enhanced diagnosis and management, especially across different age groups., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Accurate and rapid identification of causative pathogens is essential to guide the clinical management of lower respiratory tract infections (LRTIs). Here we conducted a single-centre prospective study in 284 patients suspected of lower respiratory tract infections to evaluate the utility of a nucleic acid test based on highly multiplexed polymerase chain reaction (PCR) and CRISPR-Cas12a., Methods: We determined the analytical and diagnostic performance of the CRISPR assay using a combination of reference standards, including conventional microbiological tests (CMTs), metagenomic Next-Generation Sequencing (mNGS), and clinical adjudication by a panel of experts on infectious diseases and microbiology., Results: The CRISPR assay showed a higher detection rate (63.0%) than conventional microbiological tests (38.4%) and was lower than metagenomic Next-Generation Sequencing (72.9%). In detecting polymicrobial infections, the positivity rate of the CRISPR assay (19.4%) was higher than conventional microbiological tests (3.5%) and lower than metagenomic Next-Generation Sequencing (28.9%). The overall diagnostic sensitivity of the CRISPR assay (67.8%) was higher than conventional microbiological tests (41.8%), and lower than metagenomic Next-Generation Sequencing (93.2%)., Conclusions: Considering the low cost, ease of operation, short turnaround time, and broad range of pathogens detected in a single test, the CRISPR assay has the potential to be implemented as a screening tool for the aetiological diagnosis of lower respiratory tract infections patients, especially in cases where atypical bacteria or coinfections are suspected.

Lower respiratory tract infections (LRTIs) diagnosis is challenging because noninfectious diseases mimic its clinical features. The altered host response and respiratory microbiome following LRTIs have the potential to differentiate LRTIs from noninfectious respiratory diseases (non-LRTIs). Patients suspected of having LRTIs are retrospectively enrolled and a clinical metatranscriptome test is performed on bronchoalveolar lavage fluid (BALF). Transcriptomic and metagenomic analysis profiled the host response and respiratory microbiome in patients with confirmed LRTI (n = 126) or non-LRTIs (n = 75). Patients with evidenced LRTIs exhibited enhanced pathways on chemokine and cytokine response, neutrophile recruitment and activation, along with specific gene modules linked to LRTIs status and key blood markers. Moreover, LRTIs patients exhibited reduced diversity and evenness in the lower respiratory microbiome, likely driven by an increased abundance of bacterial pathogens. Host marker genes are selected, and classifiers are developed to distinguish patients with LRTIs, non-LRTIs, and indeterminate status, achieving an area under the receiver operating characteristic curve of 0.80 to 0.86 and validated in a subsequently enrolled cohort. Incorporating respiratory microbiome features further enhanced the classifier's performance. In summary, a single metatranscriptome test of BALF proved detailed profiles of host response and respiratory microbiome, enabling accurate LRTIs diagnosis., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Study Objective: To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic., Methods: We performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024. To evaluate for changes in the frequency and costs of respiratory viral testing, we performed an interrupted time series analysis across 3 study periods: prepandemic (October 1, 2016 to March 14, 2020), early pandemic (March 15, 2020 to December 31, 2023), and late pandemic (January 1, 2023 to March 31, 2024)., Results: We included 15,261,939 encounters from 34 pediatric EDs over the 90-month study period. At least 1 viral respiratory test was performed for 460,826 of 7,311,177 prepandemic encounters (6.3%), 1,240,807 of 5,100,796 early pandemic encounters (24.3%), and 545,696 of 2,849,966 late pandemic encounters (19.1%). There was a positive prepandemic slope in viral testing (0.17% encounters/month; 95% CI 0.17 to 0.18). The early pandemic was associated with a shift change of 4.98% (95% CI 4.90 to 5.07) and a positive slope (0.54% encounters/month; 95% CI 0.54 to 0.55). The late pandemic period was associated with a negative shift (-17.80%; 95% CI -17.90 to -17.70) and a positive slope (0.42% encounters/month; 95% CI 0.41 to 0.42). The slope in testing costs increased from $5,000/month (95% CI $4,200 to $5,700) to $33,000/month (95% CI $32,000 to $34,000) during the early pandemic., Conclusion: Respiratory testing and associated costs increased during the COVID-19 pandemic and were sustained despite decreasing incidence of disease. These findings highlight a need for further efforts to clarify indications for viral testing in the ED and efforts to reduce low-value testing., (Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: To evaluate the influenza-like illness (ILI) and acute respiratory infection (ARI) case definitions in the diagnosis of COVID-19 and influenza in healthcare personnel (HCP)., Methods: We followed a cohort of 5752 HCP from November 2022 to May 2023. Symptomatic HCP were tested for SARS-CoV-2 and influenza by real-time PCR and/or rapid antigen detection test. ILI was defined as the sudden onset of ≥1 systemic symptom and ≥1 respiratory symptom. ARI was defined as the sudden onset of ≥1 respiratory symptom. Patients with respiratory symptoms were grouped either as ILI or as ARI based on the presence of fever, malaise, headache and/or myalgia., Results: Overall, 466 ILI cases and 383 ARI cases occurred. HCP with ILI had an adjusted odds ratio (aOR) of 22.05 [95% confidence interval (CI): 6.23-78.04] to be diagnosed with influenza. HCP with ARI had an aOR of 2.70 (95% CI: 1.88-3.88) to be diagnosed with COVID-19. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ILI for influenza were 96.6%, 49.9%, 18.2%, and 99.2%, respectively. The sensitivity, specificity, PPV, and NPV of ARI for COVID-19 were 51.7%, 73.6%, 84.9%, and 34.8%, respectively. ILI and ARI had an overall correct classification rate of 89.6% and 74.1%, respectively., Conclusion: Our findings support the use of both ILI and ARI case definitions in the diagnosis of influenza and COVID-19 in HCP., Competing Interests: Declaration of competing interest Dr Maltezou received an honorarium from Novavax to participate in a symposium. The authors have no conflict of interest to declare., (Copyright © 2024 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)

Respiratory infectious diseases spread rapidly and have a wide range of impacts, posing a serious threat to public health security. The development of a sensitive, accurate, and rapid detection method for respiratory viruses is crucial for disease prevention and control. However, existing methods are inadequate in satisfying the demand for accurate and convenient detection simultaneously. Therefore, an ultrasensitive point-of-care testing (POCT) platform based on a multiple aptamer recognition-based quantum dot lateral flow immunoassay (MARQ-LFIA) was developed in this work. This platform consisted of multiple high-affinity aptamers for recognizing different sites on a respiratory infectious virus protein, enhancing the efficiency of virus identification in complex environments. By combining a multiple aptamer recognition strategy with quantum dot fluorescent technique to construct LFIA test strips and pairing them with a high-gain portable fluorescence reader, excellent detection sensitivity and specificity were achieved in the case of coronavirus disease 2019 (COVID-19). The limits of detection were 1.427 pg mL -1 and 1643 U mL -1 towards the nucleocapsid protein and inactivated viruses, respectively, indicating that MARQ-LFIA improved detection sensitivity compared to reported methods. More critically, by testing thirty COVID-19 positive and twenty negative patient samples, the positive detection rate increased from 55.17% to 86.67% compared with commercially similar products. The universality of MARQ-LFIA was also investigated for diagnosing influenza B. We believe that MARQ-LFIA can be a promising POCT tool with potential applications in the areas of public health for the growing demand for precision diagnosis and treatment.

Purpose: We aimed to analyze regional variations in the assignment of International Classification of Diseases, 10th Revision (ICD-10) codes to acute respiratory infections, seeking to identify notable anomalies that suggest diverse diagnoses of the same condition., Methods: We analyzed national weekly diagnosis data for acute respiratory infections (ICD-10 codes J00-J22) in Poland from 2010 to 2019, covering all 380 county-equivalent administrative regions and encompassing 292 million consultations. Data were aggregated into age brackets. We calculated the Kendall tau correlations between shares of particular diagnoses., Results: We found staggering differences across regions in applied diagnoses that persisted even after disaggregating the data into age groups. The differences did not seem to stem from different levels of health care use, as there was no consistent pattern suggesting variability in milder diagnoses. Instead, there were numerous pairs of strongly negatively correlated codes implying classification ambiguity, with the most problematic diagnosis being J06 (acute upper respiratory infections of multiple and unspecified sites), which was used almost interchangeably with a diverse range of others, especially J00 (common cold) and J20 (bronchitis)., Conclusions: To the best of our knowledge, this is the first study using observable anomalies to analyze regional coding variability for the same respiratory infection. Although some of these discrepancies may raise concerns about misdiagnosis, the majority of cases involving interchangeably used codes did not seem to substantially impact treatment or prognosis. This suggests that ICD codes may have clinical ambiguities and could face challenges not only in fulfilling their intended purpose of generating internationally comparable health data but also in their use for comprehensive government health planning., (© 2025 Annals of Family Medicine, Inc.)

Background: The capability of mNGS in diagnosing suspected LRTIs and characterizing the respiratory microbiome in lung cancer patients requires further evaluation., Methods: This study evaluated mNGS diagnostic performance and utilized background microbial sequences to characterize LRT microbiome in these patients. GSVA was used to analyze the potential functions of identified genera., Results: Bacteria were the most common pathogens (n=74) in LRTIs of lung cancer patients, and polymicrobial infections predominated compared to monomicrobial infections (p<0.001). In diagnosing LRTIs in lung cancer patients, the pathogen detection rate of mNGS (83.3%, 70/84) was significantly higher than that of sputum culture (34.5%, 29/84) (p<0.001). This result was consistent with that of non-lung cancer patients (p<0.001). Furthermore, in the specific detection of bacteria (95.7% vs. 22.6%) and fungi (96.0% vs. 22.2%), the detection rate of mNGS was also significantly higher than that of CMTs mainly based on culture (p<0.001, p<0.001). However, in the detection of CMV/EBV viruses, there was no significant difference between the detection rate of mNGS and that of viral DNA quantification (p = 1.000 and 0.152). mNGS analysis revealed Prevotella , Streptococcus , Veillonella , Rothia , and Capnocytophaga as the most prevalent genera in the LRT of lung cancer patients. GSVA revealed significant correlations between these genera and tumor metabolic pathways as well as various signaling pathways including PI3K, Hippo, and p53., Conclusion: mNGS showed a higher pathogen detection rate than culture-based CMTs in lung cancer patients with LRTIs, and also characterizing LRT microbiome composition and revealing potential microbial functions linked to lung carcinogenesis., Competing Interests: The authors have no conflicts of interest to declare. The authors have no conflicts of interest to declare., (Copyright © 2025 Liu, Yang, Qi, Liu, Du, Ye and Zhou.)

Background: There are gaps in our understanding of the clinical characteristics and disease burden of the respiratory syncytial virus (RSV) among community-dwelling adults. This is in part due to a lack of routine testing at the point of care. More data would enhance our assessment of the need for an RSV vaccination program for adults in the United Kingdom., Objective: This study aimed to implement point-of-care-testing (POCT) in primary care to describe the incidence, clinical presentation, risk factors, and economic burden of RSV among adults presenting with acute respiratory infection., Methods: We are recruiting up to 3600 patients from at least 21 practices across England to participate in the Royal College of General Practitioners Research Surveillance Centre. Practices are selected if they undertake reference virology sampling for the Royal College of General Practitioners Research Surveillance Centre and had previous experience with respiratory illness studies. Any adult, ≥40 years old, presenting with acute respiratory infection with onset ≤10 days, but without RSV within the past 28 days, will be eligible to participate. We will estimate the incidence proportion of RSV, describe the clinical features, and risk factors of patients with RSV infection, and measure the economic burden of RSV infection., Results: A total of 25 practices across different English health administrative regions expressed interest and were recruited to participate. We have created and tested an educational program to deploy POCT for RSV in primary care. In addition to using the POCT device, we provide suggestions about how to integrate POCT into primary care workflow and templates for high-quality data recording of diagnosis, symptoms, and signs. In the 2023-2024 winter RSV detection in the sentinel network grew between October and late November. According to data from the UK Health Security Agency, the peak RSV swab positivity was in International Standards Organization week 48, 2023. Data collection remains ongoing, and results from the subset of practices participating in this study are not yet available., Conclusions: This study will provide data on the RSV incidence in the community as well as rapid information to inform sentinel surveillance and vaccination programs. This information could potentially improve clinical decision-making., International Registered Report Identifier (irrid): DERR1-10.2196/60669., (©Uy Hoang, Utkarsh Agrawal, José Manuel Ordóñez-Mena, Zachary Marcum, Jennifer Radin, Andre Araujo, Catherine A Panozzo, Orsolya Balogh, Mihir Desai, Ahreej Eltayeb, Tianyi Lu, Catia Nicodemo, Xinchun Gu, Rosalind Goudie, Xuejuan Fan, Elizabeth Button, Jessica Smylie, Mark Joy, Gavin Jamie, William Elson, Rachel Byford, Joan Madia, Sneha Anand, Filipa Ferreira, Stavros Petrou, David Martin, Simon de Lusignan. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 22.01.2025.)

Background: Respiratory infections cause a significant amount of morbidity and mortality in pediatric and young adult patients with malignancy. Bronchoscopy with bronchoalveolar lavage (BAL) is frequently utilized in the diagnostic process, but which patients would most benefit is poorly understood., Methods: A retrospective study from 2013 to 2022 examined patients with active malignancy who underwent bronchoscopy with BAL. Positive and negative clinical impacts were assessed by 3 independent reviewers according to predetermined criteria. Mixed-effects logistic regression was performed to identify factors associated with positive and negative clinical impact., Results: In total, 145 bronchoscopies met inclusion criteria with a median patient age of 12 years (interquartile range 5-17). A total of 30.3% of bronchoscopies had a positive clinical impact with 17.2% leading to a new diagnosis, most commonly Pneumocystis jirovecii pneumonia (PJP) (7.6%). Comparatively, 18.6% had a negative clinical impact, most commonly from a procedural complication (13.1%). Trimethoprim-sulfamethoxazole (TMP-SMX) initiation for treatment of suspected PJP prior to BAL (adjusted odds ratio [aOR] 11.20, 95% CI 1.32-95.29) was associated with positive clinical impact. Requirement for ICU-level care (aOR 18.85, 95% CI 3.60-98.69) or oxygen supplementation by nasal cannula prior to BAL (aOR 18.41, 95% CI 4.78-70.95) were associated with negative clinical impact while prior invasive ventilation (aOR 0.09, 95% CI 0.01-0.58) was associated with the absence of negative clinical impact., Conclusions: Patients with potential respiratory infections with high clinical suspicion for PJP who had been started on treatment TMP-SMX prior to BAL benefit most from bronchoscopy with BAL. Patients intubated prior to BAL who were deemed clinically safe for bronchoscopy tolerated the procedure better than those in the ICU not requiring intubation or those requiring supplemental oxygen via nasal cannula., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and important cause for antibiotic prescription. We aimed to describe the aetiology of LRTI in children and analyse factors associated with bacterial or viral infection., Methods: Patients aged < 19 years with a diagnosis of LRTI were identified from the Observational Medical Outcomes Partnership Common Data Model Database of Seoul National University Bundang Hospital from January 2005-July 2019, and their clinical characteristics were obtained from the electronic medical records and retrospectively reviewed., Results: Among 5,924 cases of LRTI, 74.2% were pneumonia and 25.8% were bronchiolitis/bronchitis. Patients' median age was 1.8 (interquartile range, 3.1) years and 79.9% were < 5 years old. Pathogens were identified in 37.8%; 69.1% were viral and 30.9% were bacterial/ Mycoplasma pneumoniae . Respiratory syncytial virus was most common (70.9%) among viruses and M. pneumoniae (94.6%) was most common among bacteria. Viral LRTI was associated with winter, age < 2 years, rhinorrhoea, dyspnoea, lymphocytosis, thrombocytosis, wheezing, stridor, chest retraction, and infiltration on imaging. Bacteria/ M. pneumoniae LRTI was associated with summer, age ≥ 2 years, fever, decreased breathing sounds, leucocytosis, neutrophilia, C-reactive protein elevation, and positive imaging findings (consolidation, opacity, haziness, or pleural effusion)., Conclusion: In children with LRTI, various factors associated with viral or bacterial/ M. pneumoniae infections were identified, which may serve as guidance for antibiotic prescription., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2025 The Korean Academy of Medical Sciences.)

Objectives: To review the evidence on healthcare professionals' (HCPs) and patients' views of the use of point-of-care tests (POCTs) in the management of acute respiratory tract infections (RTIs) in primary care settings., Methods: We conducted a systematic review of studies up to 28 April 2023. We included studies that included qualitative methods and results; focused on HCPs' and/or patients' views/experiences of POCTs for acute RTIs; and were conducted in primary care settings. We conducted a thematic synthesis to identify how their views on POCTs and interventions can support test use (PROSPERO registration: CRD42019150347)., Results: We included 33 studies, developing 9 categories each for HCP and patient data. We identified 38 factors affecting POCT use: 28 from HCPs and 10 from patients. Factors exist outside and within consultations, and post-consultations, illustrating that some cannot be addressed by HCPs alone. Fourteen interventions were identified that could address factors and support POCT use, with 7 interventions appearing to address the most factors. Some interventions were beyond the scope of HCPs and patients and needed to be addressed at system and organizational levels. Both groups had mixed views on the use of POCTs and highlighted implementation challenges., Discussion: This review highlights numerous factors affecting POCT use in primary care. Policy-makers planning to implement POCTs are likely to achieve more by providing multi-faceted interventions that target factors outside, within, and post-consultation. Some interventions may need to be already established before POCT introduction. Whilst evidence beyond general practice is limited, similar factors suggest that similar context-tailored interventions would be appropriate., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Acute respiratory viral infections are a major public health concern worldwide, causing significant morbidity and economic burden. Understanding the epidemiological characteristics of these infections is crucial for effective control and prevention measures. The study aimed to investigate the epidemiology of six common respiratory viral infections in Zhangzhou, Fujian Province, China. Clinical and demographic information, along with throat swabs from children and nasopharyngeal swabs from adults, were collected from 19,523 patients from Jan 2023 to Aug 2024 in Zhangzhou, Fujian Province, China. Multiplex RT-PCR was performed to detected six respiratory viral pathogens. At least one virus was detected in 6911 cases, the positivity rate was 35.40%. A total of 440 cases of mixed infection with two or more viruses were detected, and the positivity rate of co-infection was 2.25%. Age-specific analysis revealed that RSV predominantly affected children aged 0-3 years, while FluA had a broader age distribution, with significant incidences in elderly (≥ 60 years old). Seasonal peaks in viral detection were observed in Mar and Jul 2023, as well as Apr 2024. Overall, there was no statistically significant difference in viral detection rates between sexes, with the exception of the 6-14 years age group, where males exhibited a higher rate. Co-infections were more prevalent during the summer months and were particularly common among children aged 1-3 years. The study highlights the distinct age, sex, and seasonal patterns of six common respiratory viral infections in Zhangzhou, China. These findings emphasize the need for targeted age-specific and seasonal public health interventions to effectively prevent and control these infections., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical statement: The study was approved by the Ethical Research Committee of Zhangzhou Affiliated Hospital of Fujian Medical University (No. 2024LWB157). All experiments were performed under the relevant guidelines and regulations. Due to the retrospective nature, the Institutional Review Board (IRB) of Zhangzhou Affiliated Hospital of Fujian Medical University waived the need for obtaining informed consent., (© 2025. The Author(s).)

Background: Many trials, reviews, and meta-analyses have been performed on the comparison of short versus long antibiotic treatment in respiratory tract infections, generally supporting shorter treatment. The aim of this umbrella review is to assess the soundness of the current evidence base for optimal antibiotic treatment duration., Methods: A search in Ovid MEDLINE, Embase, and Clarivate Analytics Web of Science Core Collection was performed on May 1, 2024, without date and language restrictions. Systematic reviews addressing treatment durations in community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), hospital-acquired pneumonia (HAP), acute sinusitis, and streptococcal pharyngitis, tonsillitis, or pharyngotonsillitis were included. Studies from inpatient and outpatient settings were included; reviews in paediatric populations were excluded. Outcomes of interest were clinical and bacteriological cure, microbiological eradication, mortality, relapse rate, and adverse events. The quality of the reviews was assessed using the AMSTAR 2 tool, risk of bias of all included randomised controlled trials (RCTs) using the Cochrane risk-of-bias tool (version 1), and overall quality of evidence according to GRADE., Findings: We identified 30 systematic reviews meeting the criteria; they were generally of a low to critically low quality. 21 reviews conducted a meta-analysis. For CAP outside the intensive care unit (ICU; 14 reviews, of which eight did a meta-analysis) and AECOPD (eight reviews, of which five did a meta-analysis), there was sufficient evidence supporting a treatment duration of 5 days; evidence for shorter durations is scarce. Evidence on non-ventilator-associated HAP is absent, despite identifying three reviews (of which one did a meta-analysis), since no trials were conducted exclusively in this population. For sinusitis the evidence appears to support a shorter regimen, but more evidence is needed in the population who actually require antibiotic treatment. For pharyngotonsillitis (eight reviews, of which six did a meta-analysis), sufficient evidence exists to support short-course cephalosporin but not short-course penicillin when dosed three times a day., Interpretation: The available evidence for non-ICU CAP and AECOPD supports a short-course treatment duration of 5 days in patients who have clinically improved. Efforts of the scientific community should be directed at implementing this evidence in daily practice. High-quality RCTs are needed to underpin even shorter treatment durations for CAP and AECOPD, to establish the optimal treatment duration of HAP and acute sinusitis, and to evaluate shorter duration using an optimal penicillin dosing schedule in patients with pharyngotonsillitis., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

This research comprehensively investigates the epidemiological features and pathogen profile of acute respiratory infections (ARI) in Shihezi City, Xinjiang. A pivotal aspect of this study is the construction of a Bayes discriminant function for principal pathogen infections. This innovative methodology aims to furnish a robust scientific basis for the prevention and clinical management of ARI, potentially guiding more effective strategies in both public health and clinical settings. We compiled and examined data from January 2020 to June 2023, pertaining to patients admitted with acute respiratory infections at the First Affiliated Hospital of Shihezi University. This investigation focused on discerning patterns in epidemiology and pathogen etiology. Among 2110 cases of acute respiratory infections (ARI), 1736 underwent pathogenetic testing. Of these, 595 cases tested positive for at least one pathogen, marking a positivity rate of 34.27%. Viral detections, at a rate of 27.47%, were notably higher than bacterial detections, which stood at 6.51%. The most prevalent viruses identified were Human respiratory syncytial virus (hRSV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and Human adenovirus (HAdV), while the dominant bacterial pathogens included Klebsiella pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Co-infections were observed in 76 cases, accounting for 12.77% of positive diagnoses, predominantly involving hRSV in conjunction with other pathogens. In cases of acute bronchiolitis, hRSV was the most frequent pathogen, contributing to 23.10% of such cases. Similarly, in severe pneumonia cases, SARS-CoV-2 was predominant, accounting for 25.4% of these infections. The group with bacterial positivity exhibited elevated levels of C-reactive protein (CRP, 19.17 mg/L) and neutrophilic granulocyte percentage (NE%, 54.7%). The Bayes discriminant function demonstrated an initial validation accuracy of 74.9% and a cross-validation accuracy of 63.7%. The study underscores that hRSV, SARS-CoV-2, and HAdV are the primary pathogens in acute respiratory infections in the Shihezi region. Pathogen susceptibility exhibits variation across different age groups, with a higher pathogen detection rate in children compared to adults. The Bayes discriminant function shows significant promise in the classification and diagnosis of major pathogenic infections., (© 2024 Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)

Purpose: We investigated how the microscopic quality of endotracheal aspirates (ETA) impacts the performance of the Filmarray® pneumonia plus panel (FA-PP) in patients undergoing mechanical ventilation (IMV) with suspicion of lower respiratory tract bacterial infection (LRTBI)., Methods: The quality of ETA was categorized according to the number of leukocytes and buccal squamous epithelial (BSE)/field (100x magnification). G5 (< 10 BSE cells and > 25 leukocytes/field) and G4 (10-25 BSE cells and > 25 leukocytes/field) ETA were tested in parallel by the FA-PP and conventional semiquantitative culture., Results: In total, 153 ETA were graded as G5 (from 115 patients) and 56 as G4 (from 48 patients). Focusing on "conventional" bacterial species, a trend towards more positive results (P = 0.16), and co-detections (P = 0.18) was returned by G5 ETA. Although more targets were detected on G5 ETA (P = 0.005), the spectra of bacteria detected was comparable across G5 and G4 specimens. A trend towards higher bacterial burdens as quantitated by the FA-PP, and irrespective of the target, was observed in G5 (median, 10 6 genome copies/ml) vs. G4 ETA (median, 10 5 genome copies/ml). The degree of full agreement between FA-PP and culture was higher for G5 ETA (Kappa value, 0.54; 95% CI, 0.43-0.66) than for G4 ETA (Kappa value, 0.31; 95% CI, 0.11-0.49). For all bacterial targets detected, genome copy/ml numbers exceeded colony forming units (CFU)/ml counts in 1-2 log 10 , irrespective of ETA grading. The degree of correlation between genome copies/ml and CFU/ml was slightly better for G5 ETA (Rho = 0.65; P = 0.001) than for G4 ETA (Rho = 0.54; P = 0.11)., Conclusion: FA-PP testing of G5 ETA may provide more comprehensive and clinically useful information compared with G4 specimens in patients undergoing IMV with suspected LRTBI and receiving antimicrobial therapy. Yet G4 ETA may still provide useful microbiological information., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Accurately differentiating respiratory diseases caused by viruses is challenging because of the similarity in their early or clinical symptoms. Moreover, different infection sources require different treatments. However, the current diagnostic methods have limited differentiating efficiency and sensitivity. We developed a dual-system immunosensor with a bilayer fluorescent label as a signal amplifier for the on-site, sensitive, and accurate identification of multiple respiratory viruses (RVs). The nanomaterial, comprising a polystyrene (PS) nanosphere core encapsulated by two layers of CdSe@ZnS-COOH quantum dots (QDs), outperforms the conventional color and fluorescent labels in RV detection. The dual-system detection platform, comprising a PS@DQD-based lateral flow immunoassay (LFIA) and a PS@DQD-based homogeneous sensor, enables qualitative and quantitative screening of multiple respiratory viruses within 10 and 30 min, respectively, depending on the specific detection requirements for different application scenarios. This remarkable method provides 51.2 to 1000 times sensitivity improvement over commercial antigen detection kits and greater than 12.5 to 100 times improvement over QD-based immunosensors. Furthermore, we comprehensively evaluated the specificity, reproducibility, and stability of the integrated dual-system detection platform, demonstrating its reliability. Remarkably, the respiratory viral testing was validated using biological samples, thus illustrating its promise and convenience in the detection of respiratory viruses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The Seegene Allplex™ RV Master (RVM) assay is a one-step multiplex real-time reverse transcription polymerase chain reaction (RT-PCR) system for detecting eight viral respiratory pathogens from nasopharyngeal swab, aspirate, and bronchoalveolar lavage specimens. The eight RVM targets are: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Influenza A (Flu A), Influenza B (Flu B), Human respiratory syncytial virus (RSV), adenovirus (AdV), rhinovirus (HRV), parainfluenza virus (PIV), and metapneumovirus (MPV). The assay is based on Seegene's multiple detection temperature (MuDT) technology and provides cycle threshold (Ct) values for each of its viral targets upon PCR completion., Objective: We aimed to evaluate the diagnostic performance of the RVM assay by calculating sensitivity, specificity, accuracy, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Percent Agreement (PPA), Negative Percent Agreement (NPA), and Overall Percent Agreement (OPA) compared to definite diagnosis and analogous reference assays., Study Design: Diagnostic sensitivity, specificity, accuracy, PPV, and NPV were calculated by comparing the results of the RVM assay to that of definite diagnosis assays; while PPA, NPA, and OPA were calculated by comparing results of the RVM assay to that of analogous reference products. Definite diagnosis and reference methods comprised whole genome sequencing and PCR genotyping, the Allplex™ SARS-CoV-2/FluA/FluB/RSV and Respiratory Panels 1, 2, and 3 assays (Seegene), and the Xpert® Xpress SARS-CoV-2/FluA/FluB/RSV Plus assay (Cepheid). Reproducibility of the RVM assay using fully-automated and semi-automated nucleic acid (NA) extraction workflows and as performed by independent operators was also assessed. In total, 249 positive respiratory specimens and at least 50 negative specimens for each target tested were used for this evaluation study., Results: Sensitivity, specificity, accuracy, PPV, NPV, PPA, NPA, and OPA ranged from 95.7 % to 100 % for detecting all eight targets tested on the RVM assay. Reproducibility PPA, NPA, and OPA between automated and semi-automated NA extraction workflows were all >97.9 %, while the reproducibility PPA, NPA and OPA between independent operators were all 100 %., Conclusion: These results demonstrate a high level of sensitivity, specificity, accuracy and diagnostic predictive value of the RVM assay and high agreement with comparable reference assays in identifying all eight of its targets. Taken together, our study underscores the diagnostic utility of the RVM assay in detecting eight viral respiratory pathogens., Competing Interests: Declaration of Competing Interest None of the authors of this manuscript have any conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Respiratory infections are one of the leading causes of death worldwide. Rapid and accurate detection of pathogens is crucial for timely treatment. This study established a detection method based on multiplex PCR combined with capillary electrophoresis, capable of simultaneously detecting 28 common respiratory pathogens. We used specially designed homo-tag primers, significantly reducing the formation of primer dimers and improving the specificity and sensitivity of amplification. After two rounds of PCR amplification, the products were subjected to fragment analysis using the ABI 3500XL Genetic Analyzer, enabling automated result interpretation. The detection limit of this method reaches 2.77 × 10 2 copies/ml, with some pathogens reaching as low as 2.77 × 10 copies/ml. The detection of 147 clinical specimens showed that the overall consistency of this method with culture, colloidal gold, fluorescent quantitative PCR, and NGS was 75.5 %. The multiplex PCR detection method established in this study is rapid, sensitive, and high-throughput, can be used for routine screening of common pathogens in respiratory infections, providing an important basis for clinical diagnosis and treatment., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: In this study, we investigated the application value of bronchoalveolar lavage fluid (BALF) combined with targeted next-generation sequencing (tNGS) in the pathogen detection-based diagnosis of patients with lung infections., Method: A retrospective analysis was conducted on patients who underwent tracheoscopy and conventional microbiological tests (CMTs) on BALF, coupled with metagenomic next-generation sequencing (mNGS) or tNGS. This investigation encompassed individuals with suspected lung infections at Tianjin First Central Hospital from March 2023 to July 2023. Diagnostic rates based on pathogens detected via tNGS were compared with CMTs within the tNGS group. Additionally, diagnostic rates obtained through tNGS were compared with mNGS between the two groups., Results: The data of a total of 169 patients (78 in the tNGS group and 91 in the mNGS group) were collected, and 145 patients (67 in the tNGS group and 78 in the mNGS group) were finally diagnosed with lung infections. The comprehensive positive pathogen detection-based diagnosis rate for tNGS was 86.6%, with a single-pathogen lung infection diagnosis rate of 85.7% and a mixed-pathogen pulmonary infection diagnosis rate of 88.0%. In contrast, the overall positive pathogen detection-based diagnosis rate for CMTs was 38.8%, comprising a single-pathogen pulmonary infection diagnosis rate of 28.6% and a mixed-pathogen pulmonary infection diagnosis rate of 20.0%. The difference in positive diagnosis rate was deemed statistically significant (p < 0.05). In the mNGS group, the overall pathogen detection-based diagnosis rate was 89.7%, with a single-pathogen pulmonary infection diagnosis rate of 84.9%, and a 100% diagnosis rate for mixed-pathogen pulmonary infections. There was no statistically significant difference in the positive diagnosis rate when compared with the tNGS group (p > 0.05)., Conclusion: In patients with pulmonary infections, the diagnosis rate based on BALF pathogen detection using tNGS exceeded that of CMTs, showing no statistically significant difference compared to mNGS., (© 2025 The Author(s). The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)