Implementation of a Rapid Multiplex Polymerase Chain Reaction Pneumonia Panel and Subsequent Antibiotic De-escalation.

Autor: Miller MM; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA., Van Schooneveld TC; Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA., Stohs EJ; Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA., Marcelin JR; Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA., Alexander BT; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA., Watkins AB; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA., Creager HM; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA., Bergman SJ; Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA.; Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2023 Jul 17; Vol. 10 (8), pp. ofad382. Date of Electronic Publication: 2023 Jul 17 (Print Publication: 2023).
DOI: 10.1093/ofid/ofad382
Abstrakt: Background: Net effects of implementation of a multiplex polymerase chain reaction (PCR) pneumonia panel (PNP) on antimicrobial stewardship are thus far unknown. This retrospective study evaluated the real-world impact of the PNP on time to antibiotic de-escalation in critically ill patients treated for pneumonia at an academic medical center.
Methods: This retrospective, quasi-experimental study included adult intensive care unit (ICU) patients with respiratory culture results from 1 May to 15 August 2019 (pre-PNP group) and adult ICU patients with PNP results from 1 May to 15 August 2020 (PNP group) at Nebraska Medical Center. Patients were excluded for the following reasons: any preceding positive coronavirus disease 2019 PCR test, lack of antibiotic receipt, or non-respiratory tract infection indications for antibiotics. The primary outcome was time to discontinuation of anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy. Secondary outcomes included time to discontinuation of antipseudomonal therapy, frequency of early discontinuation for atypical coverage, and overall duration (in days) of antibiotic therapy for pneumonia.
Results: Sixty-six patients in the pre-PNP group and 58 in the PNP group were included. There were significant differences in patient characteristics between groups. The median time to anti-MRSA agent discontinuation was 49.1 hours in the pre-PNP and 41.8 hours in the PNP group ( P = .28). The median time to discontinuation of antipseudomonal agents was 134.4 hours in the pre-PNP versus 98.1 hours in the PNP group ( P = .47). Other outcomes were numerically but not significantly improved in our sample.
Conclusions: This early look at implementation of a multiplex PNP did not demonstrate a statistically significant difference in antibiotic use but lays the groundwork to further evaluate a significant real-world impact on antibiotic de-escalation in ICU patients treated for pneumonia.
Competing Interests: Potential conflicts of interest: T. C. V. S. reports receiving investigator-initiated grants from and consulting for bioMérieux and Thermo Fisher. E. J. S. received investigator-initiated grants from bioMérieux and from Merck unrelated to the current work. J. R. M. is a member of protocol leadership for the National Institutes of Health/National Institute of Allergy and Infectious Diseases/COVID-19 Prevention Network (CoVPN) vaccine study CoVPN 3006/Prevent COVID U and received salary support for this activity, unrelated to the current work. J. R. M. also received a consultative honorarium in 2021 for serving on a Pfizer Global Medical Grants/Mayo Clinic Global Bridges Antimicrobial Stewardship Grant review panel and an honorarium from Pew Charitable Trust in 2022, unrelated to the current work. B. T. A. is an advisory board member for Astellas Pharma and F2G and has received an investigator-initiated grant from Merck, unrelated to the current work. A. B. W. reports consulting for Thermo Fisher, unrelated to the current work. S. J. B. has received honoraria from Pfizer for serving as an advisory board member for antivirals and from bioMérieux for a presentation related to rapid diagnostic testing. All other authors report no potential conflicts.
(© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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