. 2024 Nov 22;28(1):381.

doi: 10.1186/s13054-024-05180-y.

D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care

Luis Felipe Reyes^#^{1

2

3}, Cristian C Serrano-Mayorga^#^{1

2

4}, Zhongheng Zhang⁵, Isabela Tsuji⁶, Gennaro De Pascale^{7

8}, Valeria Enciso Prieto², Mervyn Mer⁹, Elyce Sheehan¹⁰, Prashant Nasa^{11

12}, Goran Zangana¹³, Kostoula Arvaniti¹⁴, Alexis Tabah^{15

16

17}, Gentle Sunder Shrestha¹⁸, Hendrik Bracht¹⁹, Arie Zainul Fatoni²⁰, Khalid Abidi²¹, Helmi Bin Sulaiman²², Vandana Kalwaje Eshwara²³, Liesbet De Bus^{24

25}, Yoshiro Hayashi²⁶, Pervin Korkmaz²⁷, Ali Ait Hssain²⁸, Niccolò Buetti^{29

30}, Qing Yuan Goh³¹, Arthur Kwizera³², Despoina Koulenti^{33

34}, Nathan D Nielsen^{10

35}, Pedro Povoa^{36

37

38}, Otavio Ranzani^{39

40}, Jordi Rello^{41

42

43}, Andrew Conway Morris^{44

45

46}; D-PRISM Investigators

Collaborators, Affiliations

Collaborators

D-PRISM Investigators:
Luis Felipe Reyes, Zhongheng Zhang, Mervyn Mer, Alexis Tabah, Arthur Kwizera, Despoina Koulenti, Nathan D Nielsen, Pedro Povoa, Otavio Ranzani, Jordi Rello, Andrew Conway Morris, Wilson Mphandi, Adrian Ceccato, Alexis Tabah, Ahsina Jahan, Liesbet De Bus, Isabela Tsuji, Zhongheng Zhang, Luis Felipe Reyes, Manuel Jibaja, Adel Alsisi, Antoine Roquilly, Hendrik Bracht, Kostoula Arvaniti, Nancy Sandoval, Vandana Kalwaje Eshwara, Arie Zainul, Faird Zand, Gennaro De Pascale, Yoshiro Hayashi, Dimitry Viderman, Helmi Bin Sulaiman, Leonel Lagunes, Prashant Nasa, Goran Zangana, Khalid Abidi, Gentle Shrestha, Jeroen Schouten, Dabota Buowari, Madiha Hashmi, Nestor Luque, David Nora, Ali Ait Hssain, Artem Kuzovlev, Qing Yuan Goh, Mervyn Mer, Jordi Rello, Rashan Hanifa, Fredrik Sjovall, Niccollò Buetti, Tony Yeh, Pervin Korkmaz, Arthur Kwizera, Nesreen Shaban, Islam Hamed, Elyce Sheehan

Affiliations

¹ Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia.
² Clinica Universidad de La Sabana, Chia, Colombia.
³ Pandemic Sciences Institute, University of Oxford, Oxford, UK.
⁴ PhD Biosciences Program, Engineering School, Universidad de La Sabana, Chia, Colombia.
⁵ Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁶ Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁷ Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
⁸ Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁹ Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, USA.
¹¹ Critical Care Medicine NMC Specialty Hospital Dubai, Dubai, UAE.
¹² Internal Medicine, College of Medicine and Health Sciences, Al Ain, UAE.
¹³ Department of Acute and General Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
¹⁴ Intensive Care Medicine, Papageorgiou Hospital, Thessaloníki, Greece.
¹⁵ Queensland University of Technology, Brisbane, QLD, Australia.
¹⁶ Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia.
¹⁷ Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
¹⁸ Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
¹⁹ Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
²⁰ Department of Anesthesiology and Intensive Therapy, Saiful Anwar General Hospital - Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia.
²¹ Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
²² Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²³ Department of Microbiology Kasturba Medical College, Manipal Manipal Academy of Higher Education, Manipal, Karnataka, India.
²⁴ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
²⁵ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
²⁶ Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
²⁷ Pulmonary Disease Department, Ege University School of Medicine, Izmir, Turkey.
²⁸ Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
²⁹ Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland.
³⁰ IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
³¹ Division of Anaesthesiology and Perioperative Medicine, Department of Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore.
³² Department of Anaesthesia, Makerere University, Kampala, Uganda.
³³ Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
³⁴ Antibiotic Optimisation Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
³⁵ Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, USA.
³⁶ Faculdade de Ciências Médicas, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
³⁷ Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.
³⁸ Department of Intensive Care, Hospital de São Francisco Xavier, ULSLO, Lisbon, Portugal.
³⁹ Barcelona Institute for Global Health, ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
⁴⁰ Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.
⁴¹ Vall d'Hebron Institute of Research, Barcelona, Spain.
⁴² Pormation, Recherche & Évaluation (FOREVA), CHU Nîmes, Nîmes, France.
⁴³ Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁴⁴ Division of Perioperative, Acute, Critical Care and Emergency Medicine, Department of Medicine, University of Cambridge, Level 4, Addenbrooke's Hospital, Hills Road, Cambridge, UK. mozza@doctors.org.uk.
⁴⁵ Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK. mozza@doctors.org.uk.
⁴⁶ John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK. mozza@doctors.org.uk.

^# Contributed equally.

PMID: 39578900
PMCID: PMC11585090
DOI: 10.1186/s13054-024-05180-y

D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care

Luis Felipe Reyes et al. Crit Care. 2024.

. 2024 Nov 22;28(1):381.

doi: 10.1186/s13054-024-05180-y.

Authors

Collaborators

D-PRISM Investigators:
Luis Felipe Reyes, Zhongheng Zhang, Mervyn Mer, Alexis Tabah, Arthur Kwizera, Despoina Koulenti, Nathan D Nielsen, Pedro Povoa, Otavio Ranzani, Jordi Rello, Andrew Conway Morris, Wilson Mphandi, Adrian Ceccato, Alexis Tabah, Ahsina Jahan, Liesbet De Bus, Isabela Tsuji, Zhongheng Zhang, Luis Felipe Reyes, Manuel Jibaja, Adel Alsisi, Antoine Roquilly, Hendrik Bracht, Kostoula Arvaniti, Nancy Sandoval, Vandana Kalwaje Eshwara, Arie Zainul, Faird Zand, Gennaro De Pascale, Yoshiro Hayashi, Dimitry Viderman, Helmi Bin Sulaiman, Leonel Lagunes, Prashant Nasa, Goran Zangana, Khalid Abidi, Gentle Shrestha, Jeroen Schouten, Dabota Buowari, Madiha Hashmi, Nestor Luque, David Nora, Ali Ait Hssain, Artem Kuzovlev, Qing Yuan Goh, Mervyn Mer, Jordi Rello, Rashan Hanifa, Fredrik Sjovall, Niccollò Buetti, Tony Yeh, Pervin Korkmaz, Arthur Kwizera, Nesreen Shaban, Islam Hamed, Elyce Sheehan

Affiliations

¹ Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia.
² Clinica Universidad de La Sabana, Chia, Colombia.
³ Pandemic Sciences Institute, University of Oxford, Oxford, UK.
⁴ PhD Biosciences Program, Engineering School, Universidad de La Sabana, Chia, Colombia.
⁵ Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁶ Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁷ Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
⁸ Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁹ Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, USA.
¹¹ Critical Care Medicine NMC Specialty Hospital Dubai, Dubai, UAE.
¹² Internal Medicine, College of Medicine and Health Sciences, Al Ain, UAE.
¹³ Department of Acute and General Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
¹⁴ Intensive Care Medicine, Papageorgiou Hospital, Thessaloníki, Greece.
¹⁵ Queensland University of Technology, Brisbane, QLD, Australia.
¹⁶ Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia.
¹⁷ Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
¹⁸ Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
¹⁹ Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
²⁰ Department of Anesthesiology and Intensive Therapy, Saiful Anwar General Hospital - Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia.
²¹ Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
²² Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²³ Department of Microbiology Kasturba Medical College, Manipal Manipal Academy of Higher Education, Manipal, Karnataka, India.
²⁴ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
²⁵ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
²⁶ Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
²⁷ Pulmonary Disease Department, Ege University School of Medicine, Izmir, Turkey.
²⁸ Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
²⁹ Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland.
³⁰ IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
³¹ Division of Anaesthesiology and Perioperative Medicine, Department of Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore.
³² Department of Anaesthesia, Makerere University, Kampala, Uganda.
³³ Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
³⁴ Antibiotic Optimisation Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
³⁵ Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, USA.
³⁶ Faculdade de Ciências Médicas, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
³⁷ Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.
³⁸ Department of Intensive Care, Hospital de São Francisco Xavier, ULSLO, Lisbon, Portugal.
³⁹ Barcelona Institute for Global Health, ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
⁴⁰ Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.
⁴¹ Vall d'Hebron Institute of Research, Barcelona, Spain.
⁴² Pormation, Recherche & Évaluation (FOREVA), CHU Nîmes, Nîmes, France.
⁴³ Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁴⁴ Division of Perioperative, Acute, Critical Care and Emergency Medicine, Department of Medicine, University of Cambridge, Level 4, Addenbrooke's Hospital, Hills Road, Cambridge, UK. mozza@doctors.org.uk.
⁴⁵ Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK. mozza@doctors.org.uk.
⁴⁶ John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK. mozza@doctors.org.uk.

^# Contributed equally.

PMID: 39578900
PMCID: PMC11585090
DOI: 10.1186/s13054-024-05180-y

Erratum in

Correction: D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care.
Reyes LF, Serrano-Mayorga CC, Zhang Z, Tsuji I, Pascale G, Prieto VE, Mer M, Sheehan E, Nasa P, Zangana G, Arvaniti K, Tabah A, Shrestha GS, Bracht H, Fatoni AZ, Abidi K, Sulaiman HB, Eshwara VK, Bus L, Hayashi Y, Korkmaz P, Hssain AA, Buetti N, Goh QY, Kwizera A, Koulenti D, Nielsen ND, Povoa P, Ranzani O, Rello J, Morris AC; D-PRISM Investigators. Reyes LF, et al. Crit Care. 2025 Oct 16;29(1):440. doi: 10.1186/s13054-025-05610-5. Crit Care. 2025. PMID: 41102822 Free PMC article. No abstract available.

Abstract

Background: Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide.

Methods: The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study.

Results: A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5-7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training.

Conclusions: This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU. Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine.

Keywords: Antimicrobials; Bronchoscopy; Community-acquired; Hospital-acquired; Intensive care unit (ICU); Pneumonia; Surveys and questionnaires; Ventilator-associated.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This multinational cross-sectional study conducted an online self-administered questionnaire to intensive care clinicians. As an anonymized survey of clinical practice without individual patient data, the requirement for research ethics approval and formal written consent was waived by the UK Health Research Authority. Consent for publication: Not applicable. Competing interests: Nathan D. Nielsen sits on the scientific advisory boards of Adrenomed AG and Inotrem. Jordi Rello received honoraria from the Speakers' Bureau and consultancies from ROCHE, Pfizer & MSD. Andrew Conway Morris reports speaking fees from Biomerieux, Thermo-Fisher, Fischer and Paykel and Boston Scientific, he sits on the scientific advisory board of Cambridge Infection Diagnostics. Pedro Póvoa reports honoraria for lectures and advisory boards from Merck Sharp & Dohme, Gilead, Mundipharma and Pfizer, and advisory boards from Merck Sharp & Dohme, Sanofi, Gilead and Biocodex. All other authors report no competing interests.

Figures

**Fig. 2**
Duration of antibiotic regimen by disease. *CAP* Community-acquired pneumonia, *HAP* Hospital-acquired pneumonia, *VAP* Ventilator-associated pneumonia

See this image and copyright information in PMC

References

1. Collaborators GBDLRI. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18(11):1191–210. - PMC - PubMed
1. Zaragoza R, Vidal-Cortes P, Aguilar G, Borges M, Diaz E, Ferrer R, et al. Update of the treatment of nosocomial pneumonia in the ICU. Crit Care. 2020;24(1):383. - PMC - PubMed
1. Spalding MC, Cripps MW, Minshall CT. Ventilator-associated pneumonia: new definitions. Crit Care Clin. 2017;33(2):277–92. - PMC - PubMed
1. Aliberti S, Reyes LF, Faverio P, Sotgiu G, Dore S, Rodriguez AH, et al. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis. 2016;16(12):1364–76. - PubMed
1. Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT). Eur Respir J. 2017;50(3). - PubMed

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D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care

Collaborators

Affiliations

D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care

Authors

Collaborators

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

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Grants and funding

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Full Text Sources

Medical

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