Cargando…

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

OBJECTIVES: To 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). METHODS: Respiratory fluids from 100 adult patients with VHAP, receiving invasiv...

Descripción completa

Detalles Bibliográficos
Autores principales: Guillotin, Florian, Poulain, Cécile, Gaborit, Benjamin, Bouras, Marwan, Cinotti, Raphaël, Lakhal, Karim, Vourc’h, Mickael, Rozec, Bertrand, Asehnoune, Karim, Vibet, Marie-Anne, Riche, Valéry-Pierre, Gibaud, Sophie-Anne, Crémet, Lise, Roquilly, Antoine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9043525/
https://www.ncbi.nlm.nih.gov/pubmed/35493730
http://dx.doi.org/10.3389/fcimb.2022.804611
_version_ 1784694900459044864
author Guillotin, Florian
Poulain, Cécile
Gaborit, Benjamin
Bouras, Marwan
Cinotti, Raphaël
Lakhal, Karim
Vourc’h, Mickael
Rozec, Bertrand
Asehnoune, Karim
Vibet, Marie-Anne
Riche, Valéry-Pierre
Gibaud, Sophie-Anne
Crémet, Lise
Roquilly, Antoine
author_facet Guillotin, Florian
Poulain, Cécile
Gaborit, Benjamin
Bouras, Marwan
Cinotti, Raphaël
Lakhal, Karim
Vourc’h, Mickael
Rozec, Bertrand
Asehnoune, Karim
Vibet, Marie-Anne
Riche, Valéry-Pierre
Gibaud, Sophie-Anne
Crémet, Lise
Roquilly, Antoine
author_sort Guillotin, Florian
collection PubMed
description OBJECTIVES: To 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). METHODS: Respiratory 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. RESULTS: The 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. CONCLUSIONS: Our 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.
format Online
Article
Text
id pubmed-9043525
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-90435252022-04-28 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 Guillotin, Florian Poulain, Cécile Gaborit, Benjamin Bouras, Marwan Cinotti, Raphaël Lakhal, Karim Vourc’h, Mickael Rozec, Bertrand Asehnoune, Karim Vibet, Marie-Anne Riche, Valéry-Pierre Gibaud, Sophie-Anne Crémet, Lise Roquilly, Antoine Front Cell Infect Microbiol Cellular and Infection Microbiology OBJECTIVES: To 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). METHODS: Respiratory 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. RESULTS: The 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. CONCLUSIONS: Our 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. Frontiers Media S.A. 2022-04-13 /pmc/articles/PMC9043525/ /pubmed/35493730 http://dx.doi.org/10.3389/fcimb.2022.804611 Text en Copyright © 2022 Guillotin, Poulain, Gaborit, Bouras, Cinotti, Lakhal, Vourc’h, Rozec, Asehnoune, Vibet, Riche, Gibaud, Crémet and Roquilly https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cellular and Infection Microbiology
Guillotin, Florian
Poulain, Cécile
Gaborit, Benjamin
Bouras, Marwan
Cinotti, Raphaël
Lakhal, Karim
Vourc’h, Mickael
Rozec, Bertrand
Asehnoune, Karim
Vibet, Marie-Anne
Riche, Valéry-Pierre
Gibaud, Sophie-Anne
Crémet, Lise
Roquilly, Antoine
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Cellular and Infection Microbiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9043525/
https://www.ncbi.nlm.nih.gov/pubmed/35493730
http://dx.doi.org/10.3389/fcimb.2022.804611
work_keys_str_mv AT guillotinflorian potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT poulaincecile potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT gaboritbenjamin potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT bourasmarwan potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT cinottiraphael potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT lakhalkarim potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT vourchmickael potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT rozecbertrand potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT asehnounekarim potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT vibetmarieanne potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT richevalerypierre potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT gibaudsophieanne potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT cremetlise potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy
AT roquillyantoine potentialimpactofrapidmultiplexpcronantimicrobialtherapyguidanceforventilatedhospitalacquiredpneumoniaincriticallyillpatientsaprospectiveobservationalclinicalandeconomicstudy