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

Abstract

ObjectivesTo 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).MethodsRespiratory 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.ResultsThe 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.ConclusionsOur 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.

Assessing the Utility of Multiplexed Polymerase Chain Reaction in Detecting Microorganisms Causing Infections in Critically ill Patients

“…Nucleic acid amplification methods, such as multiplexed polymerase chain reaction (PCR), have shown high diagnostic efficacy [11] and can reduce the time to detect some antibiotic resistance mechanisms [12,13]. These methods can optimize the initial antibiotic treatment, reducing broad-spectrum antibiotic use and associated risks [14,15]. However, they have limitations, such as false negatives and positives.…”

Performance and Impact on Antibiotic Prescriptions of a Multiplex PCR in a Real-Life Cohort of Critically Ill Patients with Suspected Ventilated Pneumonia: A Retrospective Monocentric Observational Study

“…Most of these studies simulated the impact of m-PCR results by comparing the antibiotics prescribed in practice by clinicians unaware of the m-PCR results to those chosen in theory by experts informed of the m-PCR results. The anticipated proportion of antibiotic de-escalation when using m-PCR was around 40% in the literature [16,21,[28][29][30]. For instance, Guillotin et al showed only 37% of predicted broad-spectrum antibiotic therapies when using m-PCR compared with 88% when following clinical guidelines [28].…”

“…The anticipated proportion of antibiotic de-escalation when using m-PCR was around 40% in the literature [16,21,[28][29][30]. For instance, Guillotin et al showed only 37% of predicted broad-spectrum antibiotic therapies when using m-PCR compared with 88% when following clinical guidelines [28]. Buchan et al reported a potential de-escalation or discontinuation of antibiotic therapy based on m-PCR results in 48% of patients, resulting in an average saving of 6.2 antibiotic days/patient.…”

Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

“…Findings from that study demonstrated potential cost-savings with the mPCR test bundle, primarily due to no longer needing to perform certain standard of care tests, such as singleplex nasal PCRs or urinary antigen testing. Furthermore, in a prospective study of VAP patients that received mPCR, Guillotin et al demonstrated that the cost to prevent one day of non-optimized antibiotics with mPCR was more expensive but more effective than relying on antimicrobial therapy recommendations alone [41]. This evidence points toward the value of mPCR in enhancing patient care while potentially streamlining healthcare expenditures.…”