HIRA-TAN detects pathogens of pneumonia with a progressive course despite antibiotic treatment

Respir Investig. 2019 Jul;57(4):337-344. doi: 10.1016/j.resinv.2019.03.001. Epub 2019 Apr 26.


Background: Empiric antibiotics are administered for pneumonia when the causative pathogens are unidentified. Pathogen-directed therapy is impeded by negative culture results and/or culture time lag. This circumstance necessitates a salvage method for pathogen identification, especially when antibiotic therapy has failed. Here, we aimed to preliminarily investigate the HIRA-TAN method in pneumonia with a progressive course despite prior empiric antibiotic therapy.

Methods: This prospective study was conducted for patients who were referred to Dr. Zainoel Abidin Hospital, Aceh, Indonesia, from December 2016 to January 2017, owing to pneumonia with a progressive course. Sputum or pleural effusion was subjected to culture and the HIRA-TAN assay. The HIRA-TAN identified the candidate causative pathogens based on the difference in the cycle threshold (Ct) between the targeted pathogen and the single-copy human gene.

Results: Patients (n=27) were predominantly males (22 patients, 81.5%), with a median age of 62 years. All patients had comorbid disease and were classified as hospital-acquired pneumonia (25 patients, 92.6%) with multilobar infiltrates (22 patients, 81.5%). Bacterial culture identified causative pathogen(s) in some (14 patients, 51.8%), whereas the HIRA-TAN identified pathogen(s) in most (23 patients, 85.2%). The rapid pathogen identification by the HIRA-TAN will provide valuable information in guiding pathogen-directed therapy.

Conclusions: The result warrants a larger clinical trial to confirm the clinical efficacy of the HIRA-TAN in patients with progressive pneumonia despite previous antibiotic treatment.

Keywords: Empiric antibiotics; Microbiological techniques; Molecular typing; Multiplex polymerase chain reaction; Pneumonia.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Disease Progression
  • Female
  • Healthcare-Associated Pneumonia / drug therapy*
  • Healthcare-Associated Pneumonia / microbiology*
  • Humans
  • Klebsiella pneumoniae / isolation & purification*
  • Klebsiella pneumoniae / pathogenicity
  • Male
  • Middle Aged
  • Moraxella catarrhalis / isolation & purification*
  • Moraxella catarrhalis / pathogenicity
  • Prospective Studies
  • Pseudomonas aeruginosa / isolation & purification*
  • Pseudomonas aeruginosa / pathogenicity
  • Real-Time Polymerase Chain Reaction / methods*
  • Streptococcus pneumoniae / isolation & purification*
  • Streptococcus pneumoniae / pathogenicity
  • Treatment Failure


  • Anti-Bacterial Agents