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Dr. Raúl Ortiz de Lejarazu
PhD, Medicine, Medical Microbiology, and Bacteriology; Emeritus Director of the National Influenza Center in Valladolid and Scientific Advisor for Cepheid in Spain.
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19. Februar 2026
ATEMWEGSGESUNDHEIT
Artikel
Transforming Respiratory Infection Diagnosis: Embracing Molecular Innovation in Clinical Practice
By Dr. Raúl Ortiz de Lejarazu, Ph.D. Medicine, Medical Microbiology, and Bacteriology; Emeritus Director of the National Influenza Center in Valladolid and Scientific Advisor for Cepheid in Spain.
A Turning Point in Respiratory Diagnosis
Respiratory infections remain one of the most frequent causes of healthcare visits in Spain. Yet for too long, clinicians were forced to make decisions without the benefit of rapid and accurate diagnostics. That landscape is changing, thanks to molecular innovation.
"In clinical medicine and microbiology, we often operate in the dark. Now that we can have light, we must take advantage of it."
In May 2025, a multidisciplinary Delphi consensus, endorsed by nine leading Spanish specialists from different medical societies, was published in the Journal of Diagnostic Microbiology & Infectious Disease1. I had the honor of coordinating this group. Together, we delivered updated national recommendations that recognize the central role of rapid molecular diagnostics in managing acute respiratory infections (ARIs).
From Slow Cultures to Rapid Molecular Results
Just two decades ago, cell culture and antigen tests could take up to 48 hours,2 far too slow to influence treatment in a meaningful way. Molecular diagnostics have changed everything.
Today, rapid PCR tests can identify pathogens like influenza, RSV, and SARS-CoV-2. For Flu, it enables treatment within the 12 first hours after symptoms onset, reducing the illness, accelerating return to normal activities, and avoiding unnecessary antibiotic use3.
"What once took days now takes minutes. This is not only a scientific breakthrough, but also a clinical imperative."
Key Recommendations from the Delphi Consensus1
Our consensus highlights the importance of rapid PCR testing for:
- All hospitalized patients with symptomatic ARIs
- High-risk populations: elderly, immunocompromised, and patients with comorbidities
- Pediatric patients requiring specialized care
Rapid diagnostics also support:
- Antimicrobial stewardship by reducing unnecessary antibiotic use
- Improved patient flow and reduced nosocomial transmission across hospitals and long-term care centers
- Improved cost-effectiveness in hospitals (vs. antigen tests)
Primary Care: The Next Frontier
One key challenge remains: extending molecular testing into primary care and emergency services, where most respiratory cases begin4. This requires investment and evidence, not only in cost-effectiveness, but also in social and organizational impact.
"Our next step is to illuminate the first points of patient contact with the same clarity we’ve brought to hospitals."
The working group is calling for broader implementation of point-of-care molecular tests and further studies to validate their impact in community-based settings.
A call to action
The tools now exist to transform how we diagnose and manage respiratory infections. It is time to use them.
These recommendations are not just technical, they are transformational. They offer a blueprint for more responsive, efficient, and patient-centered care across Spain’s healthcare system.
"We have overcome the diagnostic delays. The era of fast, precise, and actionable information is here."
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Literatur:
1. Ortiz-de-Lejarazu R, Sagué M, Eiros JM, de la Flor J, Villar-Álvarez F, Fernández-Prada M, Jiménez-Jiménez AB, Sanz F, Gamazo JJ, Yáñez L, Gómez A, Rodríguez-Ledo P, Ortega J, Molero JM, Reina J, Solà-Morales O. Viral respiratory tract infections diagnosis: a Spanish survey and consensus approach. Diagn Microbiol Infect Dis. 2025 Sep;113(1):116831.
2. Vila J, Zboromyrska Y, Vergara A, Alejo I, Rubio E, Álvarez MJ, Puig J, Marcos MA. Métodos moleculares de diagnóstico de infecciones respiratorias. ¿Ha cambiado el esquema diagnóstico? Enferm Infecc Microbiol Clin. 2016;34(Supl 3):40–46. doi:10:1016/S0213-005X(16)30193-6
3. Stiver G. The treatment of influenza with antiviral drugs. CMAJ. 2003 Jan 7;168(1):49-56. PMID: 12515786; PMCID: PMC139319.
4. Vigilancia de Infección Respiratoria Aguda en Atención Primaria y Hospitales. Gripe, COVID-19 y VRS. Informe Anual Temporada 2023-2024. Centro Nacional de Epidemiología - Centro Nacional de Microbiología Instituto de Salud Carlos III. 2025 Feb. https://cne.isciii.es/documents/d/cne/informe_anual_sivira_2023-24_20250211
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