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What is the syndromic approach? Why does it matter?

George had been feeling under the weather for days when he finally dragged himself to the hospital, looking for help. 

When poor George arrived at the hospital Emergency Room (ER), he didn’t tell the triage nurse he was suffering from pneumonia; all he could do was reel off his symptoms. “I feel miserable, I feel weak, I have no appetite and I’ve been coughing for four days,” he said. “Help me. Please.”

In George’s case, as in most, it takes more than a list of symptoms to arrive at a diagnosis. Health care professionals (HCPs) also look for signs of illness—indicators that can be detected or measured objectively, like a heart murmur heard through a stethoscope, or a fever measured by placing a thermometer under the tongue.

A syndrome consists of symptoms and signs

“When you put symptoms and signs together, this is called a syndrome,” says Dr. Mark Miller, Chief Medical Officer of bioMérieux Inc. “The concept of a syndrome is important because this is how a patient presents to their doctor or nurse.”

Does George have pneumonia, the flu, heart failure, or another type of respiratory infection or disease? Dr. Miller says there are several good reasons to get the diagnosis right:

  • George is suffering: he has the right to expect a timely diagnosis and effective therapy and relief
  • Identifying the precise cause of George’s problems facilitates the selection of the appropriate therapy
  • Having a definite diagnosis determines the appropriate infection control for George and those with whom he has been in contact

We can add one more item to this list: having the means to quickly identify pathogens will also help George get out of the hospital and back home sooner, which is win-win for both George and the hospital. Clearly, the ability to pinpoint the pathogen responsible for a syndrome of signs and symptoms is key to achieving a successful outcome.

bioMérieux leads in taking the syndromic approach

bioMérieux is a world leader in applying the syndromic approach to diagnostic testing. “Our approach mimics the way a patient presents in the hospital or clinic,” reveals Dr. Miller. “The most common syndromes are respiratory and gastrointestinal (GI), with others down the list, like sepsis syndromes and meningitis. We have panels that include 20 or more pathogen tests for each of these syndromes.”

Accurate test results in a fraction of the time

George appears to have a respiratory syndrome, so the HCP takes a simple and easily-obtained sample from George’s nose and sends it to the lab to be tested using the respiratory panel in the FilmArray® system from bioMérieux. Compared to conventional testing, results from the FilmArray® test can be back in the HCP’s hands in about an hour (versus up to several days) and, using this single sample, can positively identify any one of 20 different respiratory pathogens.

A syndromic approach isn’t always necessary: if a patient has been hospitalized for two weeks and develops diarrhea, we know the most likely cause is C. difficile. Because the list of potential pathogens is very long, syndromic testing is more appropriate for patients who, like George, just come into the ER with respiratory or GI symptoms.

“Conventional testing can result in a lot of waiting and, of course, ongoing discomfort for the patient—perhaps even an unnecessary hospitalization,” says Dr. Miller. “It becomes very cost-effective to simultaneously test for multiple pathogens that could be responsible for a syndrome, rather than just look for one cause at a time.”

“The ability to test for multiple pathogens in a single procedure results in better management of the patient and better infection control.”

– Mark Miller, MD

Having a diagnosis can be reassuring 

A syndromic approach to testing is also helpful because patients are reassured when they receive a precise diagnosis rather than an educated guess. “Being able to say, ‘We have a positive test for a virus. You can go home and rest without the need for unnecessary antibiotics’ gives patients a great deal of comfort and is more rewarding for the HCP,” says Dr. Miller.

In addition to shorter hospital stays and less unnecessary time in isolation (which is very expensive), taking a syndromic approach encourages the responsible use of antibiotics.

Preserving antibiotics’ effectiveness

“Antibiotic resistance is a growing problem around the world. Antimicrobial stewardship means giving the right antibiotic in the right dose to the right patient at the right time. You can do that when you have definitive test results that come back rapidly,” says Dr. Miller. “Reducing the inappropriate use of antibiotics is important. FilmArray® is one of the major tools hospitals can use in their antimicrobial stewardship program.”

Getting back to poor George. How long will he wait, and how many tests will be ordered to diagnose the cause of his illness? We can only hope the ER he visited is served by a laboratory that has adopted the syndromic approach, so that he can look forward to a quick recovery.

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