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Multicenter Study
. 2020 Jul 14;24(1):434.
doi: 10.1186/s13054-020-03114-y.

Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia

Céline Monard  1 , Jonathan Pehlivan  2 , Gabriel Auger  3   4 , Sophie Alviset  5 , Alexy Tran Dinh  6   7 , Paul Duquaire  1 , Nabil Gastli  8 , Camille d'Humières  9   10 , Adel Maamar  11   12 , André Boibieux  13 , Marion Baldeyrou  14 , Julien Loubinoux  15 , Olivier Dauwalder  16   17 , Vincent Cattoir  3   18   19 , Laurence Armand-Lefèvre  9   10 , Solen Kernéis  20   21 ; ADAPT study group
Collaborators, Affiliations
Multicenter Study

Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia

Céline Monard et al. Crit Care. .

Abstract

Background: Improving timeliness of pathogen identification is crucial to allow early adaptation of antibiotic therapy and improve prognosis in patients with pneumonia. We evaluated the relevance of a new syndromic rapid multiplex PCR test (rm-PCR) on respiratory samples to guide empirical antimicrobial therapy in adult patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP).

Methods: This retrospective multicenter study was conducted in four French university hospitals. Respiratory samples were obtained from patients with clinical and radiological signs of pneumonia and simultaneously tested using conventional microbiological methods and the rm-PCR. A committee composed of an intensivist, a microbiologist, and an infectious diseases specialist retrospectively assessed all medical files and agreed on the most appropriate antimicrobial therapy for each pneumonia episode, according to the results of rm-PCR and blinded to the culture results. The rm-PCR-guided antimicrobial regimen was compared to the empirical treatment routinely administered to the patient in standard care.

Results: We included 159 pneumonia episodes. Most patients were hospitalized in intensive care units (n = 129, 81%), and episodes were HAP (n = 68, 43%), CAP (n = 54, 34%), and VAP (n = 37, 23%). Conventional culture isolated ≥ 1 microorganism(s) at significant level in 95 (60%) patients. The syndromic rm-PCR detected at least one bacteria in 132 (83%) episodes. Based on the results of the rm-PCR, the multidisciplinary committee proposed a modification of the empirical therapy in 123 (77%) pneumonia episodes. The modification was a de-escalation in 63 (40%), an escalation in 35 (22%), and undetermined in 25 (16%) patients. In microbiologically documented episodes (n = 95), the rm-PCR increased appropriateness of the empirical therapy to 83 (87%), as compared to 73 (77%) in routine care.

Conclusions: Use of a syndromic rm-PCR test has the potential to reduce unnecessary antimicrobial exposure and increase the appropriateness of empirical antibiotic therapy in adult patients with pneumonia.

Keywords: Antimicrobial stewardship; Antimicrobials; Biofire® FilmArray®; Multiplex PCR; Pneumonia; Syndromic tests.

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Conflict of interest statement

bioMerieux SA provided IUO tests for the study. bioMerieux SA did not interfere with data collection and analysis, nor with manuscript preparation. Dr. Julien Textoris participated in the elaboration of the protocol.

SK declares grants from bioMérieux and lecture fees and conference invitations from bioMérieux, MSD, and Accelerate Diagnostics.

CM received lecture fees from bioMerieux SA.

ATD and NG report no conflicts of interest.

VC reports personal fees from Accelerate Diagnostics, Astellas, bioMérieux, Correvio, Curetis, Eumédica, Menarini, Mylan, Pfizer, and Sanofi.

LA received lecture fees from Pfizer, MSD, Biocodex, and Biomerieux.

All authors have submitted the ICMJE form for disclosure of potential conflicts of interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Fig. 1
Fig. 1
Pathogens targeted by the BioFire® FilmArray® Pneumonia Panel
Fig. 2
Fig. 2
Consensual ranking of β-lactams according to both their spectrum and their resistance-promoting potential according to Weiss et al., Clinical Microbiology and Infection 2015 “Elaboration of a Consensual Definition of De-Escalation Allowing a Ranking of β-Lactams”
See this image and copyright information in PMC

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