Clinical evaluation of the BioFire Respiratory Pathogen Panel for the guidance of empirical antimicrobial therapy in critically ill patients with hospital-acquired pneumonia : A multicenter, quality improvement project
Copyright © 2024. Published by Elsevier Masson SAS..
BACKGROUND: We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP).
METHODS: We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy.
RESULTS: A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%-50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before versus 0.55 ± 1.13 days after the intervention (p = 0.56).
CONCLUSION: Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:43 |
|---|---|
| Enthalten in: |
Anaesthesia, critical care & pain medicine - 43(2024), 2 vom: 21. März, Seite 101353 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Poulain, Cécile [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anti-Bacterial Agents |
|---|
| Anmerkungen: |
Date Completed 25.03.2024 Date Revised 25.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.accpm.2024.101353 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368451453 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368451453 | ||
| 003 | DE-627 | ||
| 005 | 20240325234842.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240215s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.accpm.2024.101353 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1346.xml |
| 035 | |a (DE-627)NLM368451453 | ||
| 035 | |a (NLM)38355044 | ||
| 035 | |a (PII)S2352-5568(24)00011-0 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Poulain, Cécile |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical evaluation of the BioFire Respiratory Pathogen Panel for the guidance of empirical antimicrobial therapy in critically ill patients with hospital-acquired pneumonia |b A multicenter, quality improvement project |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.03.2024 | ||
| 500 | |a Date Revised 25.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024. Published by Elsevier Masson SAS. | ||
| 520 | |a BACKGROUND: We aimed to determine whether implementing antimicrobial stewardship based on multiplex bacterial PCR examination of respiratory fluid can enhance outcomes of critically ill patients with hospital-acquired pneumonia (HAP) | ||
| 520 | |a METHODS: We conducted a quality improvement study in two hospitals in France. Adult patients requiring invasive mechanical ventilation with a diagnosis of HAP were included. In the pre-intervention period (August 2019 to April 2020), antimicrobial therapy followed European guidelines. In the «intervention» phase (June 2020 to October 2021), treatment followed a multiplex PCR-guided protocol. The primary endpoint was a composite endpoint made of mortality on day 28, clinical cure between days 7 and 10, and duration of invasive mechanical ventilation on day 28. The primary outcome was analyzed with a DOOR strategy | ||
| 520 | |a RESULTS: A total of 443 patients were included in 3 ICUs from 2 hospitals (220 pre-intervention; 223 intervention). No difference in the ranking of the primary composite outcome was found (DOOR: 50.3%; 95%CI, 49.9%-50.8%). The number of invasive mechanical ventilation-free days at day 28 was 10.0 [0.0; 19.0] in the baseline period and 9.0 [0.0; 20.0] days during the intervention period (p = 0.95). The time-to-efficient antimicrobial treatment was 0.43 ± 1.29 days before versus 0.55 ± 1.13 days after the intervention (p = 0.56) | ||
| 520 | |a CONCLUSION: Implementation of Rapid Multiplex PCR to guide empirical antimicrobial therapy for critically ill patients with HAP was not associated with better outcomes. However, adherence to stewardship was low, and the study may have had limited power to detect a clinically important difference | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antimicrobial stewardship | |
| 650 | 4 | |a Antimicrobial therapy | |
| 650 | 4 | |a Hospital-acquired pneumonia | |
| 650 | 4 | |a Mechanical ventilation | |
| 650 | 4 | |a Molecular diagnosis | |
| 650 | 7 | |a Anti-Infective Agents |2 NLM | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Launey, Yoann |e verfasserin |4 aut | |
| 700 | 1 | |a Bouras, Marwan |e verfasserin |4 aut | |
| 700 | 1 | |a Lakhal, Karim |e verfasserin |4 aut | |
| 700 | 1 | |a Dargelos, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Crémet, Lise |e verfasserin |4 aut | |
| 700 | 1 | |a Gibaud, Sophie-Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Corvec, Stéphane |e verfasserin |4 aut | |
| 700 | 1 | |a Seguin, Philippe |e verfasserin |4 aut | |
| 700 | 1 | |a Rozec, Bertrand |e verfasserin |4 aut | |
| 700 | 1 | |a Asehnoune, Karim |e verfasserin |4 aut | |
| 700 | 1 | |a Feuillet, Fanny |e verfasserin |4 aut | |
| 700 | 1 | |a Roquilly, Antoine |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Anaesthesia, critical care & pain medicine |d 2015 |g 43(2024), 2 vom: 21. März, Seite 101353 |w (DE-627)NLM247623199 |x 2352-5568 |7 nnns |
| 773 | 1 | 8 | |g volume:43 |g year:2024 |g number:2 |g day:21 |g month:03 |g pages:101353 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.accpm.2024.101353 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 43 |j 2024 |e 2 |b 21 |c 03 |h 101353 | ||