Clinical evaluation of the BioFire Respiratory Pathogen Panel for the guidance of empirical antimicrobial therapy in critically ill patients with hospital-acquired pneumonia: A multicenter, quality improvement project.

Autor: Poulain C; Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France. Electronic address: cecile.poulain@chu-nantes.fr., Launey Y; Univ Rennes, CHU Rennes, Department of Anaesthesia, Critical Care and Perioperative Medicine, F-35000 Rennes, France., Bouras M; Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France., Lakhal K; Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France., Dargelos L; Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France., Crémet L; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France; Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France., Gibaud SA; Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France., Corvec S; Nantes Université, CHU Nantes, Service de bactériologie-hygiène, pôle de biologie, Nantes, France., Seguin P; Univ Rennes, CHU Rennes, Department of Anaesthesia, Critical Care and Perioperative Medicine, F-35000 Rennes, France., Rozec B; Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France., Asehnoune K; Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France., Feuillet F; Nantes Université, CHU de Nantes, DRI, Département promotion, cellule vigilances, Nantes, France; Nantes Université, CHU de Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, Nantes, France., Roquilly A; Nantes Université, CHU Nantes, INSERM, Anesthesie Réanimation, CIC 0004, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France.
Jazyk: angličtina
Zdroj: Anaesthesia, critical care & pain medicine [Anaesth Crit Care Pain Med] 2024 Apr; Vol. 43 (2), pp. 101353. Date of Electronic Publication: 2024 Feb 12.
DOI: 10.1016/j.accpm.2024.101353
Abstrakt: Background: We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP).
Methods: We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy.
Results: A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%-50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before versus 0.55 ± 1.13 days after the intervention (p = 0.56).
Conclusion: Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference.
(Copyright © 2024. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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