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. 2024 Jul 29;14(1):118.
doi: 10.1186/s13613-024-01348-5.

Performance and impact of rapid multiplex PCR on diagnosis and treatment of ventilated hospital-acquired pneumonia in patients with extended-spectrum β-lactamase-producing Enterobacterales rectal carriage

Pierre Bay  1   2   3 , Vincent Fihman  4   5 , Paul-Louis Woerther  4   5 , Bastien Peiffer  6 , Ségolène Gendreau  7   8 , Romain Arrestier  7   8 , Pascale Labedade  7   8 , Elsa Moncomble  7   8 , Antoine Gaillet  7   8 , Guillaume Carteaux  7   8 , Nicolas de Prost  7   8 , Armand Mekontso Dessap #  7   8 , Keyvan Razazi #  7   8
Affiliations

Performance and impact of rapid multiplex PCR on diagnosis and treatment of ventilated hospital-acquired pneumonia in patients with extended-spectrum β-lactamase-producing Enterobacterales rectal carriage

Pierre Bay et al. Ann Intensive Care. .

Abstract

Background: Antimicrobial stewardship (AMS) for ventilator-associated pneumonia (VAP) or ventilated hospital-acquired pneumonia (vHAP) in extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) carriers is challenging. BioFire® FilmArray® Pneumonia plus Panel (mPCR) can detect bacteria and antibiotic resistance genes, including blaCTX-M, the most common ESBL-encoding gene.

Methods: This monocentric, prospective study was conducted on a group of ESBL-E carriers from March 2020 to August 2022. The primary objective was to evaluate the concordance between the results of mPCR and conventional culture performed on respiratory samples of ESBL-E carriers to investigate suspected VAP/vHAP. The secondary objective was to appraise the impact of performing or not mPCR on initial antibiotic therapy adequacy in ESBL-E carriers with confirmed VAP/vHAP.

Results: Over the study period, 294 patients with ESBL-E carriage were admitted to the ICU, of who 168 (57%) were mechanically ventilated. (i) Diagnostic performance of mPCR was evaluated in suspected 41 episodes of VAP/vHAP: blaCTX-M gene was detected in 15/41 (37%) episodes, where 9/15 (60%) were confirmed ESBL-E-induced pneumonia. The culture and blaCTX-M were concordant in 35/41 (85%) episodes, and in all episodes where blaCTX-M was negative (n = 26), the culture never detected ESBL-E. (ii) The impact of mPCR on initial antibiotic therapy adequacy was assessed in 95 episodes of confirmed VAP/vHAP (22 episodes were tested with mPCR and 73 without); 47 (49%) episodes were ESBL-E-induced, and 24 (25%) were carbapenem-resistant bacteria-induced. The use of mPCR was significantly associated with higher prescription of adequate empirical antibiotic therapy in the multivariable logistic regression (adjusted odds ratio (aOR) (95% CI) of 7.5 (2.1-35.9), p = 0.004), propensity-weighting (aOR of 5.9 (1.6-22.1), p = 0.008), and matching-cohort models (aOR of 5.8 (1.5-22.1), p = 0.01).

Conclusion: mPCR blaCTX-M showed an excellent diagnostic value to rule out the diagnosis of ESBL-E related pneumonia in ESBL-E carriers with suspected VAP/vHAP. In addition, in patients with confirmed VAP/vHAP, a mPCR-based antibiotic therapy was associated with an increased prescription of adequate empirical antibiotic therapy. Performing mPCR on respiratory samples seems to be a promising tool in ESBL-E carriers with suspected vHAP/VAP. However, if mPCR is used in very low pre-test clinical probability of pneumonia, due to the high sensitivity and the rate of overdiagnosed pneumonia, the risk of overconsumption of carbapenem may prevail. Further studies are warranted.

Keywords: Antimicrobial stewardship; Carbapenem; ESBL; Intensive care unit; Multiplex PCR; Nosocomial pneumonia; Ventilator-associated pneumonia.

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Conflict of interest statement

KR reports personal fees from Shionogi and MSD. GC reports personal fees from Air Liquide Medical System, GE Healthcare, Dräger, Fisher and Paykel, Medtronic and Löwenstein, outside the submitted work. AMD reports grants from Fischer Paykel, Baxter, Philips, Ferring and GSK, personal fees from Air Liquide, Baxter, Amomed, Getingue and Addmedica, outside the submitted work. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study. Panel A ESBL-E carriers hospitalized in the ICU over the study period. Panel B mPCR microbiological performance in ESBL-E carriers with suspected vHAP/VAP. Panel C Impact of the use of mPCR on the decision making to initiate antibiotic therapy in ESBL-E carriers with confirmed vHAP/VAP. CTX-M Cefotaximase-Munich, ESBL-E extended-spectrum β-lactamase-producing Enterobacterales, mPCR multiplex polymerase chain reaction, VAP ventilator associated pneumonia, vHAP ventilated hospital-acquired pneumonia
Fig. 2
Fig. 2
Sankey of diagram of antibiotic stewardship according to the use or not of mPCR in ESBL-E carriers with confirmed vHAP/VAP. ATB antibiotic therapy, ESBL-E extended-spectrum β-lactamase-producing Enterobacterales, mPCR multiplex polymerase chain reaction, MV mechanical ventilation, VAP ventilator associated pneumonia, vHAP ventilated hospital-acquired pneumonia
See this image and copyright information in PMC

References

    1. De Bus L, Gadeyne B, Steen J, Boelens J, Claeys G, Benoit D, et al. A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit: results from a prospective four-year registration. Crit Care Lond Engl. 2018;22(1):241.10.1186/s13054-018-2178-7 - DOI - PMC - PubMed
    1. Detsis M, Karanika S, Mylonakis E. ICU acquisition rate, risk factors, and clinical significance of digestive tract colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae: a systematic review and meta-analysis. Crit Care Med. 2017;45(4):705–14. 10.1097/CCM.0000000000002253 - DOI - PubMed
    1. Haute Autorité de Santé. Antibiothérapie des infections à entérobactéries et à Pseudomonas aeruginosa chez l’adulte : place des carbapénèmes et de leurs alternatives. https://www.has-sante.fr/jcms/c_2968915/fr/antibiotherapie-des-infection.... Accessed 16 Sep 2022.
    1. Barbier F, Bailly S, Schwebel C, Papazian L, Azoulay É, Kallel H, et al. Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae. Intensive Care Med. 2018;44(5):616–26. 10.1007/s00134-018-5154-4 - DOI - PubMed
    1. Bush K, Bradford PA. Epidemiology of β-lactamase-producing pathogens. Clin Microbiol Rev. 2020;33(2):e00047-e119. 10.1128/CMR.00047-19 - DOI - PMC - PubMed

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