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Multiplex PCR in Donor and Recipient Bronchoalveolar Lavage to Guide Early Antibiotic Prophylaxis Adaptation in Lung
Damien Barrau1, Geoffrey Brioude2, Alban Todesco2
1Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, 13015 Marseille, France.
Abstract:
Background/Objectives: International guidelines recommend the use of antibiotic prophylaxis for lung transplantation (LT). Although multiplex PCR (mPCR) has been shown to hasten antibiotic adaptation during pneumonia, its use to guide antibiotic prophylaxis in patients undergoing LT has not been described. We aimed to determine whether mPCR in bronchoalveolar lavage (BAL) in donor and recipient allows the early adaptation of antibiotic prophylaxis during LT. Methods: a retrospective, single-center study to evaluate the proportion of patients for whom mPCR (FilmArray Pneumonia Plus Panel®, Biomérieux (FAPP)) in the donor and recipient BAL resulted in an early modification of antibiotic prophylaxis. We also compared the time to results using mPCR and standard microbiology and the time spent with inadequate antibiotic prophylaxis. Results: Forty-one patients were included. Donor and recipient mPCR resulted in the early adaptation of antibiotic prophylaxis in 10 (24%) patients. Standard microbiology confirmed the results of mPCR in 90% of them. FAPP resulted in an antibiotic escalation based on donor (9/10) or recipient (1/10) BAL identification, mainly Group 3 Enterobacterales and non-fermenting Gram-negative bacilli. The time to results was 1.7 (1.5-2.4) h for mPCR vs. 74.3 (41.5-92.7) h for standard microbiology (p < 0.001) on donor BAL and 1.7 (1.5-2.4) h vs. 92.8 (48.4-112.9) h (p < 0.001) on recipient BAL. Patients with mPCR-based adaptation had a 71.9 (30.7-92.1) h reduction in the duration of inadequate antibiotic prophylaxis. Conclusions: mPCR in donor and recipient BAL during LT might lead to faster adaptation and a reduction in the time spent with inadequate antibiotic prophylaxis.
Insights
Multiplex PCR (mPCR) in lung transplant (LT) recipients and donors significantly speeds up antibiotic prophylaxis adaptation. This method reduces the time patients receive inadequate antibiotic treatment, improving patient outcomes.
Area of Science:
- Medical Microbiology
- Transplant Surgery
- Infectious Diseases
Background:
- International guidelines advocate antibiotic prophylaxis for lung transplantation (LT).
- Multiplex PCR (mPCR) accelerates antibiotic selection in pneumonia but its role in LT prophylaxis is unexplored.
- Early adaptation of antibiotic prophylaxis is crucial in LT to prevent complications.
Purpose of the Study:
- To assess if mPCR in donor and recipient bronchoalveolar lavage (BAL) enables early adaptation of antibiotic prophylaxis during LT.
- To compare the turnaround time of mPCR versus standard microbiology for guiding LT prophylaxis.
- To evaluate the duration of inadequate antibiotic prophylaxis in LT patients.
Main Methods:
- Retrospective, single-center study of 41 lung transplant patients.
- Utilized multiplex PCR (FilmArray Pneumonia Plus Panel) on donor and recipient BAL fluid.
- Compared mPCR results and turnaround times with standard microbiology methods.
Main Results:
- mPCR led to early antibiotic prophylaxis adaptation in 24% of patients (10/41).
- mPCR turnaround time was significantly faster: ~1.7 hours vs. over 74 hours for standard microbiology (p < 0.001).
- mPCR-guided adaptation reduced inadequate antibiotic prophylaxis duration by an average of 71.9 hours.
Conclusions:
- mPCR testing of donor and recipient BAL fluid can facilitate timely adaptation of antibiotic prophylaxis in lung transplantation.
- This approach may significantly decrease the period of inadequate antibiotic exposure.
- mPCR offers a valuable tool for optimizing antimicrobial stewardship in lung transplant recipients.
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