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Protocolized antimicrobial stewardship following filmarray pneumonia plus panel testing in mechanically ventilated
Sofía Cano1, Mª Ángeles Clari1, Eliseo Albert1
1Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.
Abstract:
We evaluated the impact of the implementation of a protocolized list of antimicrobial stewardship actionables based upon the results of the Biofire Filmarray pneumonia plus panel (FA-PP) on antimicrobial use in mechanically-ventilated critically ill patients with lower respiratory tract infection and its cost-effectiveness compared to the standard-of-care. Retrospective, pre- and post-FA-PP-implementation study including 213 consecutive patients, of which most (n = 198) were under empirical antimicrobial therapy (EAT) at the time of testing. Endotracheal aspirates were usually processed for microbiological testing. The primary study outcome was the number of participants with administration of antimicrobials or subjected to changes in EAT deemed to be appropriate. Secondary outcomes were the time to antimicrobial stewardship; and the total number of days on antimicrobial therapy. Conventional culture retrieved clinically significant results in 48/113 (42.4%) and 37/100 (37%) in the pre-FA-PP and post- FA-PP periods (P = 0.48). FA-PP increased the detection yield compared to conventional culture. The spectrum of bacterial species involved was comparable across both periods. Appropriate and proportionate adjustment of EAT was made more frequently in the post-FA-PP phase (54/89; 60.6%) than in the pre-FA-PP phase (55/109; 50.4%) (P = 0.15) and at earlier times. When considering the entire pre-FA-PP and post-FA-PP cohorts, no difference was noticed on duration of antimicrobial treatments (mean, 7.1 days vs. 7.6 days, respectively (P = 0.32). Nevertheless, adequate selection of patients for FA-PP testing enabled a reduction in the total number of antibiotic treatment days, with an Incremental Cost-Effectiveness Ratio of €151/day. Antimicrobial stewardship driven by the FA-PP panel results was sped up relative to that based upon standard practice with at least a comparable appropriateness and a rather negligible increase in costs.
Insights
The Biofire Filmarray pneumonia plus panel (FA-PP) improved antimicrobial stewardship in critically ill patients with lower respiratory tract infections. This diagnostic tool enhanced appropriate antimicrobial adjustments and reduced overall antibiotic treatment days, proving cost-effective.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Microbiology
Background:
- Lower respiratory tract infections (LRTI) in mechanically ventilated patients require effective antimicrobial stewardship.
- Empirical antimicrobial therapy (EAT) is common, necessitating rapid and accurate diagnostics.
- Conventional microbiological testing has limitations in speed and yield for LRTI pathogens.
Purpose of the Study:
- To evaluate the impact of the Biofire Filmarray pneumonia plus panel (FA-PP) on antimicrobial use and cost-effectiveness in mechanically ventilated patients with LRTI.
- To compare the diagnostic yield and stewardship outcomes of FA-PP versus standard microbiological testing.
- To assess the timeliness and appropriateness of antimicrobial therapy adjustments based on FA-PP results.
Main Methods:
- Retrospective study comparing pre- and post-FA-PP implementation periods.
- Inclusion of 213 mechanically ventilated critically ill patients with LRTI, most on EAT.
- Analysis of endotracheal aspirates using conventional culture and FA-PP, focusing on antimicrobial adjustments and treatment duration.
Main Results:
- FA-PP increased pathogen detection yield compared to conventional culture.
- Appropriate adjustment of EAT occurred more frequently and earlier post-FA-PP implementation.
- No significant difference in total antimicrobial treatment duration between groups, but FA-PP enabled reduction in antibiotic days with a favorable Incremental Cost-Effectiveness Ratio (€151/day).
Conclusions:
- Antimicrobial stewardship driven by FA-PP results is faster than standard practice.
- FA-PP provides comparable appropriateness of antimicrobial therapy with a negligible increase in costs.
- The FA-PP panel is a valuable tool for optimizing antimicrobial use and improving cost-effectiveness in critically ill patients with LRTI.
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