Ask AI
Back Back
Rapid Syndromic Panel for Respiratory Infection
Rapid Syndromic Panels for Respiratory Tract Infection: Who Should Receive Them?

Released: August 25, 2025

Michael J. Satlin
Michael J. Satlin, MD, MS, FIDSA
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • To guide treatment and infection control, laboratory-based syndromic panels are most useful for determining infection etiology in specific patient populations, such as those who are critically ill or who are immunocompromised due to a malignancy or receipt of a transplant.
  • Point-of-care syndromic panels may be helpful for those practicing in outpatient offices/clinics who treat patients with cancer, transplant, and/or autoimmune disease.

Syndromic panels have revolutionized clinical microbiology and can detect the most common causes of upper and lower respiratory tract infections. But it is important to consider in whom to use these tests because they are expensive and may not impact the management of many patients. 

Laboratory-Based Syndromic Panels
Many multiplex panels can detect bacteria, including atypical bacteria, and more viruses of the upper respiratory tract than we have treatments for. Yet the question remains: which patients should receive these tests?

For the average patient presenting to an emergency department (ED) or urgent care setting, it may not matter whether they have rhinovirus, human metapneumovirus, or respiratory syncytial virus (RSV). But for patients who are immunocompromised­­—such as those receiving chemotherapy or who have received a transplant—the etiology of their infection might matter because they may be eligible for certain therapies (eg, ribavirin for RSV) and knowing that they are infected with a specific virus could make other etiologies less likely and affect decisions on the timing of subsequent immunosuppressive therapies.

It is also important to consider how ill patients are. The sicker the patient, the more important it is to establish the etiology of their infection. For example, it is more important to establish the etiology of a respiratory tract infection for patients admitted to the intensive care unit vs those who are otherwise well and going to be discharged from the ED.

Furthermore, if you have patients in a transplant or hematology unit who have an upper respiratory tract infection, it is helpful to determine exactly what they are infected with to implement the optimal isolation precautions and to detect emerging outbreaks within the unit.

In addition, other multiplex panels can detect the common causes of lower respiratory tract infections—from community- and hospital-acquired bacterial pneumonia to viruses, atypical bacteria, and key antibiotic resistance genes. The decision of which patients should receive these panels is more of a hospital-wide consideration, requiring discussion between the facility’s antimicrobial stewardship program and clinical microbiology laboratory.

At my organization, we primarily run these lower respiratory tract multiplex syndromic panels on bronchoalveolar lavage (BAL) fluid specimens because we think patients undergoing bronchoscopies and BAL fluid collection are more likely to be acutely ill and are at highest risk for having an antimicrobial-resistant bacterial infection.

Point-of-care Syndromic Panels
Like laboratory-based panels, point-of-care syndromic panels can be used for patients who are immunocompromised or very sick, specifically in oncology, transplant, rheumatology, gastroenterology, and other specialties who care for patients with autoimmune diseases, such as lupus or inflammatory bowel disease. I do not know if point-of-care syndromic panels will improve patient care in all outpatient settings, but they could be useful for these specific specialties.

In terms of their possible use in primary care, the main issue is that the tests are expensive, and patients can receive a large bill. The benefit of syndromic panel testing vs a typical point-of-care test for influenza and COVID-19, for example, is less clear in the primary care setting than it is for the examples I listed above. 

Your Thoughts
If your institution or practice uses syndromic panels to detect respiratory tract infections, what factors influence your decision on which patient populations in which to use them?

Continue