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Observational Study
. 2022 Apr 13:12:804611.
doi: 10.3389/fcimb.2022.804611. eCollection 2022.

Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study

Florian Guillotin  1 , Cécile Poulain  1 , Benjamin Gaborit  2 , Marwan Bouras  1 , Raphaël Cinotti  3 , Karim Lakhal  3 , Mickael Vourc'h  3 , Bertrand Rozec  3 , Karim Asehnoune  1 , Marie-Anne Vibet  4 , Valéry-Pierre Riche  5 , Sophie-Anne Gibaud  6 , Lise Crémet  6 , Antoine Roquilly  1
Affiliations
Observational Study

Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study

Florian Guillotin et al. Front Cell Infect Microbiol. .

Abstract

Objectives: To investigate the potential impact of the syndromic multiplex FilmArray® Pneumonia plus Panel (FAPP) on the antimicrobial treatment guidance of patients with ventilated hospital-acquired pneumonia (VHAP).

Methods: Respiratory fluids from 100 adult patients with VHAP, receiving invasive mechanical ventilation in three intensive care units from one French university hospital, were tested prospectively using FAPP. Conventional cultures were performed in parallel as routine practice. Clinicians were left blinded to the FAPP results. Antimicrobial therapies based on FAPP results were simulated by independent blinded experts according to a predefined algorithm and compared to 1) those prescribed in practice according to local guidelines (real-life), and 2) those that complied with the international ERS/ESICM/ESCMID/ALAT recommendations. The primary endpoint was the number of days of broad-spectrum antimicrobial therapy. Secondary endpoints were the rates of microbiological treatment failure and cost-effectiveness ratio.

Results: The predicted median duration of broad-spectrum antibiotics was 0 [0-1.25] day in the FAPP-based simulation, versus 2 [0-6] days in real-life (p<0.0001) and 2 [2-3.25] days in the recommendations-based simulation (p<0.0001). Treatment failure was predicted in 3% of cases with FAPP results versus observed in 11% in real-life (p=0.08) and 6% with recommendations-based simulation (p=0.37). The incremental cost-effectiveness ratio was 1 121 € [-7021; 6794] to avoid one day of non-optimized antimicrobial therapy.

Conclusions: Our results suggest that using FAPP in patients with VHAP has the potential to reduce the use of broad-spectrum antimicrobial therapy without increasing the risk of microbial treatment failure.

Keywords: biomolecular diagnosis; empiric treatment; hospital-acquired pneumonia; intensive care unit; pneumonia.

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Conflict of interest statement

Author BG was employed by Service de Maladies Infectieuses et Tropicales et CIC 1413. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Duration of broad-spectrum antimicrobial therapy. (A, B). Numbers of days of (A) broad-spectrum antimicrobial therapy (activity against P. aeruginosa), and (B) carbapenems with anti-pseudomonas aeruginosa activity in real-life, in the FAPP-based simulated treatment, and the recommendations-based simulated treatment. FAPP, FilmArray® Pneumonia plus Panel. *p < 0.01, ***p < 0.001.
Figure 2
Figure 2
Sankey chart of real-life empirical treatments implemented without FAPP (left column), antimicrobial therapies simulated with the results of FAPP (Middle column), and antimicrobial therapies simulated by following the actual recommendations (right column). Red lines stand for antibiotic escalation, green for de-escalation, and yellow for no changes.
See this image and copyright information in PMC

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