Multiplex PCR Pneumonia Panel in Critically Ill Patients Did Not Modify Mortality: A Cohort Study
Luisa Fernanda Riaño-Sánchez1, Carlos Arturo Alvarez-Moreno1,2, Marcela Godoy3
1Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá 111321, Colombia.
Abstract:
In critically ill patients, identification of the pathogen may allow for the timely adjustment of antibiotics and improved outcomes. Background/Objectives: The aim of the study was to assess whether performing a multiplex PCR pneumonia panel (PN-panel) in patients with pneumonia in the intensive care unit (ICU) had any effect on mortality or other important clinical outcomes. Methods: A retrospective cohort study was conducted on adult patients with pneumonia who required ICU admission in four institutions in Bogotá between November 2019 and June 2023. Mortality at 30 days, the length of the hospital and ICU stay, the duration of antibiotics, and their association with the PN-panel performance were evaluated using an inverse probability of the treatment weighting to adjust for covariates and potential confounders. Results: A total of 304 patients were included, including 150 with PN-panel, with a mean age of 65.0 years (SD 14.6). SARS-CoV-2 was the primary etiologic agent in 186 (61.2%) patients, and 256 (84.2%) patients had community-acquired pneumonia. No association was found between 30-day mortality and the PN-panel, with a HR of 1.14 (CI 95% 0.76-1.70), although the assessment by an infectious disease specialist was associated with a lower mortality HR of 0.29 (CI 95% 0.19-0.45). There was no association between the PN-panel and antimicrobial therapy duration or other clinical outcomes. Conclusions: The use of the PN-panel was not associated with changes in mortality, the duration of antibiotics, or hospital and ICU stays. To acquire greater rational decision-making, microbiological data produced by this test should be interpreted with aid of an antimicrobial stewardship program oriented by an infectious disease team that could take the clinical data and integrate the information provided.
Insights
Multiplex PCR pneumonia panels (PN-panels) in the ICU did not impact patient mortality or length of stay. Expert infectious disease specialist assessment, however, was linked to reduced mortality in pneumonia patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Timely pathogen identification in critically ill patients can optimize antibiotic therapy and improve outcomes.
- Pneumonia is a common infection in intensive care unit (ICU) patients, necessitating effective diagnostic tools.
Purpose of the Study:
- To evaluate the impact of multiplex PCR pneumonia panels (PN-panels) on mortality and clinical outcomes in ICU patients with pneumonia.
- To assess the association between PN-panel use and length of hospital stay, ICU stay, and antibiotic duration.
Main Methods:
- A retrospective cohort study involving 304 adult pneumonia patients admitted to the ICU across four institutions.
- Inverse probability of treatment weighting was used to adjust for confounders when analyzing the association between PN-panel performance and outcomes.
- Key outcomes included 30-day mortality, hospital and ICU length of stay, and duration of antibiotic therapy.
Main Results:
- No significant association was found between PN-panel use and 30-day mortality (HR 1.14; 95% CI 0.76-1.70).
- Assessment by an infectious disease specialist was associated with significantly lower mortality (HR 0.29; 95% CI 0.19-0.45).
- The PN-panel did not demonstrate an association with changes in antibiotic duration or other clinical outcomes.
Conclusions:
- The utilization of multiplex PCR PN-panels in ICU pneumonia patients did not correlate with improved mortality or reduced hospital/ICU length of stay.
- Effective interpretation of PN-panel results requires integration with clinical data by an infectious disease team within an antimicrobial stewardship program.
- Clinical judgment and specialist infectious disease consultation appear more impactful on mortality than the PN-panel alone in this cohort.
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