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. 2025 Sep 25;29(1):403.
doi: 10.1186/s13054-025-05632-z.

Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study

Daniele Roberto Giacobbe  1   2 , Greta Cattardico  3   4 , Claudia Bartalucci  3 , Vincenzo Di Pilato  5   6 , Marco Muccio  4 , Alessandro Limongelli  3   4 , Alessio Signori  7 , Alessandra Bandera  8   9 , Bruno Cacopardo  10 , Edoardo Campanella  10 , Alessandro Caroli  11   12 , Annamaria Cattelan  13 , Marta Colaneri  14 , Andrea Cortegiani  15   16 , Laura Curci  17 , Gennaro De Pascale  11   12 , Giuseppe Vittorio De Socio  17 , Filippo Del Puente  18 , Antonino Di Fede  15 , Chiara Fanelli  19 , Nicholas Geremia  20   21 , Maddalena Giannella  22   23 , Giacomo Grasselli  8   24 , Chiara Maci  25 , Ivana Maida  19 , Davide Mangioni  9 , Andrea Marino  10 , Maria Mazzitelli  13 , Maria Chiara Meloni  19 , Marco Merli  26 , Elena Momesso  27 , Chiara Oltolini  26 , Carlo Pallotto  17 , Sandro Panese  20   21 , Matteo Passerini  28   29 , Emanuele Pontali  18 , Daniele Riccucci  22 , Matteo Rinaldi  22   23 , Marco Ripa  25   30 , Vincenzo Scaglione  13 , Francesco Saverio Serino  31 , Vincenzo Spagnuolo  25   30 , Giulia Spurio  15 , Stefania Tigano  18 , Carlo Torti  32   33 , Giovanna Travi  26 , Laura Magnasco  4 , Federica Portunato  4 , Federica Briano  4 , Malgorzata Mikulska  3   4 , Lorenzo Ball  5   34 , Chiara Robba  5   34 , Nicolò Patroniti  5   34 , Denise Battaglini  5   34 , Mauro Giacomini  35 , Gian Maria Rossolini  36   37 , Maurizio Sanguinetti  11   38 , Paola Morici  6 , Anna Marchese  5   6 , Antonio Vena  3   4 , Matteo Bassetti  3   4 ; RAPID-SITA PHENOTYPES investigators
Collaborators, Affiliations

Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study

Daniele Roberto Giacobbe et al. Crit Care. .

Abstract

Background: Ventilator-associated bacterial pneumonia (VABP) is a common infection in critically ill patients in intensive care units (ICU), with attributable mortality of up to 13%, and its etiological diagnosis remains challenging.

Materials and methods: We conducted a multicenter, prospective, observational study within the MULTI-SITA platform to assess the impact on relevant clinical and antimicrobial stewardship outcomes of the use of a molecular syndromic panel (BIOFIRE® FILMARRAY® Pneumonia plus), in addition to a standard approach based on culture. The primary outcome measure was 30-day mortality from VABP onset.

Results: Overall, 237 patients with VABP were included in the study. In multivariable analysis, SOFA score (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.04–1.22, p = 0.003), previous isolation of carbapenem-resistant Pseudomonas aeruginosa (HR 3.02, 95% CI 1.25–7.32, p = 0.015), and solid neoplasm (HR 2.15, 95% CI 1.12–4.14, p = 0.022) were associated with increased mortality, while no association was registered for the molecular syndromic panel performed (HR 1.07, 95% CI 0.59–1.93, p = 0.825). In secondary analyses, use of the molecular syndromic panel resulted in more events of either de-escalation or initiation of appropriate antibiotic therapy at day 1 from VABP onset in comparison with a standard approach based on culture only (41.3% vs. 27.8%, p = 0.041).

Conclusion: The use of a molecular syndromic panel in patients with VABP was able to impact antibiotic decisions, without an unfavorable effect on mortality. Further study is necessary to assess the long-term effects in terms of antimicrobial stewardship of molecular syndromic panels-based antibiotic treatment decisions.

Supplementary Information: The online version contains supplementary material available at 10.1186/s13054-025-05632-z.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Rapid diagnosis; Rapid molecular tests; Ventilator-associated pneumonia.

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Conflict of interest statement

Declarations. Ethical approval: The MULTI-SITA project was approved by the ethics committee of the coordinating center (Liguria Region Ethics Committee, registry number 390/2020), with a subsequent amendment authorizing the conduct of the RAPID-SITA PHENOTYPES study within the MULTI-SITA project. The other participating centers followed the local ethical committees requirements and started to enroll patients prospectively once activated. Conscious patients at time of enrollment signed an informed consent to participate in the study. A waiver of informed consent for data collection from unconscious patients at the time of enrollment due to severe clinical conditions was obtained within the ethics committee approval, in line with the observational nature of the analyses and in order not to bias research results towards low mortality prejudicing scientific validity. Competing interests: Outside the submitted work, Matteo Bassetti has received funding for scientific advisory boards, travel, and speaker honoraria from Cidara, Gilead, Menarini, MSD, Mundipharma, Pfizer, and Shionogi. Outside the submitted work, Daniele Roberto Giacobbe reports investigator-initiated grants from Pfizer, Shionogi, Menarini, Tillotts Pharma, and Gilead Italia, travel support from Pfizer, and speaker/advisor fees from Pfizer, bioMérieux, Advanz Pharma, Menarini, and Tillotts Pharma. Outside the submitted work, Vincenzo Di Pilato reports travel and speaker honoraria from Arrow Diagnostics. Outside the submitted work, Andrea Cortegiani has received fees for lectures/advisory board membership from Gilead, MSD, Mundipharma, and Pfizer. Outside the submitted work, Gian Maria Rossolini has received research grants for the laboratory, funding for scientific advisory boards and/or speaker engagements from ADA, Advanz Pharma, Alifax, Arrow Diagnostics, bioMérieux, Cepheid, Diesse, Hain Life Sciences, Menarini, Meridian, MSD, Pfizer, Qiagen, Q-linea, Quantamatrix, Quidel, Qvella, SD Biosensor, Seegene, Shionogi, Syncells, Viatris, and Zambon. The other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow-chart of the patient inclusion process. BSI, bloodstream infection; VABP, ventilator-associated bacterial pneumonia
Fig. 2
Fig. 2
Unadjusted cumulative mortality up to Day 30 in patients with VABP. Unadjusted cumulative mortality up to Day 30 in patients with VABP in whom the PNplus panel was performed (red line) and patients with VABP in whom only BAL culture was performed (blue line). The time of origin was set as the day of VABP onset. Death was the event of interest and right-censoring was applied at the end of follow-up (ICU discharge or Day 30, whichever came first). BAL, bronchoalveolar lavage; ICU, intensive care unit; VABP, ventilator-associated bacterial pneumonia
Fig. 3
Fig. 3
Composite outcome of antibiotic de-escalation in patients who received appropriate therapy from VABP onset (day 0) or initiation of an appropriate therapy from day 1 in those who did not initiate an appropriate therapy on day 0. p values from chi square test. VABP, ventilator-associated bacterial pneumonia. In patients with PNplus panel performed, de-escalation was obtained through discontinuation of anti-Gram positive agents (15/24, 62.5%), discontinuation of anti-Gram negative agents (5/24, 20.8%), change to an agent with narrower spectrum (3/24, 12.5), or discontinuation of ani-anaerobes agents (1/24,4.2%). In patients with only culture performed, de-escalation was obtained through discontinuation of anti-Gram positive agents (4/8, 50.0%), discontinuation of anti-Gram negative agents (2/8, 25.0%), or change to an agent with narrower spectrum (2/8, 25.0%). In patients with PNplus panel performed, initiation of appropriate therapy from day 1 occurred because of initiation of any therapy on day 1 (19/28, 67.9%), or change of therapy on day 1 (9/28, 32.1%). In patients with only culture performed, initiation of appropriate therapy from day 1 occurred because of initiation of any therapy on day 1 (15/17, 88.2%), or change of therapy on day 1 (2/17, 11.8%)
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