Performance and impact of rapid multiplex PCR on diagnosis and treatment of ventilated hospital-acquired pneumonia in patients with extended-spectrum β-lactamase-producing Enterobacterales rectal carriage
Authors' conclusion
mPCR blaCTX-M showed an excellent diagnostic value to rule out the diagnosis of ESBL-E related pneumonia in ESBL-E carriers with suspected VAP/vHAP. In addition, in patients with confirmed VAP/vHAP, a mPCR-based antibiotic therapy was associated with an increased prescription of adequate empirical antibiotic therapy.
Study context
- Population
- ICU patients with ESBL-E rectal carriage with suspected or confirmed ventilator-associated pneumonia (VAP)/ventilated hospital-acquired pneumonia (vHAP)168 (57%) mechanically ventilated
- Participants
- 294 patients
- Exposure
- mPCR (BioFire FilmArray Pneumonia plus Panel) vs conventional culture; mPCR vs no mPCR for initial antibiotic therapy
- mPCRn = 22
- Without mPCRn = 73reference
- Outcome
- Concordance between mPCR and conventional culture on respiratory samples for suspected VAP/vHAP
Methodological detailsmonocentric, March 2020 to August 2022
- Monocentric
- March 2020 to August 2022
Main finding
As reported in the abstract
Concordance of mPCR blaCTX-M with conventional culture for ESBL-E (suspected VAP/vHAP)
- Suspected VAP/vHAP episodes evaluated
- 41
- blaCTX-M detected
- 15/41 (37%)
- Confirmed ESBL-E-induced pneumonia among blaCTX-M-positive episodes
- 9/15 (60%)
- Culture never detected ESBL-E in blaCTX-M-negative episodes
- n = 26
- Culture and blaCTX-M concordant
- 35/41 (85%)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aOR (95% CI) | P value | |
|---|---|---|---|
| Adequate empirical antibiotic therapy in confirmed VAP/vHAP (95 episodes)mPCR vs without mPCR · multivariable logistic regression | 7.5 (2.1–35.9) | P = 0.004 | |
| Adequate empirical antibiotic therapy in confirmed VAP/vHAP (95 episodes)mPCR vs without mPCR · propensity-weighting | 5.9 (1.6–22.1) | P = 0.008 | |
| Adequate empirical antibiotic therapy in confirmed VAP/vHAP (95 episodes)mPCR vs without mPCR · matching-cohort | 5.8 (1.5–22.1) | P = 0.01 | |
| 0.050.21520Adjusted odds ratio (log scale) |
- Adequate empirical antibiotic therapy in confirmed VAP/vHAP (95 episodes) — ESBL-E-induced episodes
- 47 (49%)
- Adequate empirical antibiotic therapy in confirmed VAP/vHAP (95 episodes) — Carbapenem-resistant bacteria-induced episodes
- 24 (25%)
Original publication
Performance and impact of rapid multiplex PCR on diagnosis and treatment of ventilated hospital-acquired pneumonia in patients with extended-spectrum β-lactamase-producing Enterobacterales rectal carriage. Ann Intensive Care. Published 29 July 2024. doi:10.
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