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Published on: August 30, 2018
Antibiotic stewardship with multiplex PCR for pneumonia in intensive care patients: A retrospective study
Sine Wichmann1, Dorthe Ørsnes Christensen1, Claus Antonio Juel Jensen2
1Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.
Background:
Early initiation of targeted antibiotic therapy is important to achieve the best patient outcomes in intubated patients with pneumonia in the intensive care unit (ICU). This study aimed to investigate the applicability of multiplex polymerase chain reaction (PCR) in an ICU by comparing the test results to the results of conventional microbiological methods to assess the possible impact on antibiotic therapy.
Method:
This retrospective study investigated adult patients with pneumonia on mechanical ventilation in the ICU. Tracheal aspirates were collected within 24h after intubation and the initiation of mechanical ventilation. Samples were initially tested by conventional microbiological methods and subsequently re-evaluated with rapid multiplex PCR on stored samples. Concordance between the two methods was assessed. An intensivist and a microbiologist retrospectively reviewed the patients' electronic health records for relevant clinical details to evaluate the potential impact of multiplex PCR results on antibiotic therapy.
Results:
In this study, 76 patients were enrolled and 55 (72.4%) tested positive for 95 pathogens using multiplex PCR, while conventional microbiological methods identified 40 pathogens in 32 (42.2%) patients. Concordance between the two methods was observed in 42 (55.3%) patients. Multiplex PCR detected 39 additional pathogens in 31 (40.7%) patients. Retrospective analysis indicated potential antibiotic de-escalation in 35 (46.1%) patients and escalation in 4 (5.3%) patients. Multiplex PCR significantly reduced the turnaround time for test results.
Conclusion:
In ICU patients with suspected pneumonia, multiplex PCR identified a higher number of pathogens compared to CMM. A retrospective assessment indicates that the use of multiplex PCR could potentially have prompted the de-escalation of antibiotic therapy in nearly half of the patients. Therefore, multiplex PCR may serve as a supplement to CMM in guiding antibiotic stewardship.
Insights
Multiplex PCR identified more pathogens in ICU pneumonia patients than conventional methods. This rapid test could guide antibiotic de-escalation in nearly half of patients, improving stewardship.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Intensive Care Medicine
Background:
- Early targeted antibiotic therapy is crucial for optimal outcomes in intubated ICU patients with pneumonia.
- Conventional microbiological methods (CMM) may have limitations in rapidly identifying pathogens.
Purpose of the Study:
- To evaluate the applicability and impact of multiplex PCR in an ICU setting.
- To compare multiplex PCR results with CMM for diagnosing pneumonia in intubated patients.
- To assess the potential influence of multiplex PCR on antibiotic therapy decisions.
Main Methods:
- Retrospective study of adult ICU patients with pneumonia on mechanical ventilation.
- Tracheal aspirates analyzed by both CMM and multiplex PCR.
- Retrospective review of electronic health records to assess impact on antibiotic therapy.
Main Results:
- Multiplex PCR detected significantly more pathogens (95 vs. 40) and identified pathogens in more patients (72.4% vs. 42.2%) compared to CMM.
- Concordance between methods was 55.3%; multiplex PCR identified 39 additional pathogens in 40.7% of patients.
- Potential for antibiotic de-escalation in 46.1% and escalation in 5.3% of patients; reduced turnaround time.
Conclusions:
- Multiplex PCR identifies more pathogens than CMM in ICU pneumonia.
- Multiplex PCR could potentially guide antibiotic de-escalation in a significant proportion of patients.
- Multiplex PCR may supplement CMM for enhanced antibiotic stewardship in ICUs.
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