Impact of point-of-care multiplex PCR for Mycoplasma pneumoniae community-acquired pneumonia in the emergency department.

OBJECTIVES

Community-acquired pneumonia (CAP) due to Mycoplasma pneumoniae is a frequent and challenging diagnosis in Emergency Departments (EDs), often leading to unnecessarily broad-spectrum or ineffective antibiotic therapy. We hypothesize that rapid diagnostic tools, such as point-of-care (POC) devices, could improve initial antibiotic therapy appropriateness and reduce unnecessary additional diagnostic tests.

METHODS

We conducted a retrospective, single-centre, study involving 81 patients visiting our ED with Mycoplasma pneumoniae CAP diagnosed between January 2023 and June 2024. Patients were divided into two groups depending on whether their nasopharyngeal swab, taken to detect viruses or selected bacteria such as Mycoplasma pneumoniae, was handled at the ED with a POC device (POC group) or at the main laboratory (Lab group). Primary outcome was the appropriateness of initial antibiotic therapy, defined as the use of macrolide (or tetracycline or fluoroquinolone in allergic patients) alone or, in case of severe disease, in combination with third-generation cephalosporin.

RESULTS

Initial antibiotic therapy was more frequently appropriated in patients of the POC group than in patients of the Lab group (28 of 43 [65%] vs. 6 of 38 [16%], adjusted OR: 9.9, 95% confidence interval: 3.4 to 29.1; p < .001). Point-of-care testing was associated with fewer additional biological and radiological tests performed in the ED.

CONCLUSION

POC improved the management of Mycoplasma pneumoniae CAP by increasing the appropriateness of initial antimicrobial therapy and reducing unnecessary additional diagnostic procedures. Larger multicentre studies are needed to confirm these findings, assess the impact on overall healthcare costs, and investigate the integration of POC devices into routine clinical workflows.