351. Antibiotic Management Decisions and Use of a Multiplex PCR Panel for Pneumonia Diagnosis Among Critically Ill Patients with COVID-19

Abstract

BackgroundAntibiotic use among patients with COVID-19 is common, exceeds the prevalence of probable bacterial co-infection, and promotes development of resistant organisms. Lack of diagnostic microbiological data may prolong empiric broad-spectrum therapy. Here we evaluate the use of the BioFire FilmArray pneumonia panel (PP), a novel rapid diagnostic test, and antibiotic decisions among intensive care unit (ICU) patients with COVID-19.MethodsWe conducted a retrospective review of adult ICU patients admitted with COVID-19 between January 2020 and May 2021 at an academic medical center. ICU patients who underwent bronchoscopy/bronchoalveolar lavage (BAL) with PP (PP group) were matched by age (< 65 or ≥65), BMI (< 30 or ≥30), and BAL date (within 60 days) to ICU patients who did not undergo BAL (no-BAL group). PP patients were matched by age and BMI to ICU patients who underwent BAL without PP (no-PP group). Antibiotic use was compared between groups. Chi squared analysis, t-test, and ANOVA were used for comparisons as appropriate. Results65 patients were included; the majority were male (65%), < 65 years (86%), and had BMI ≥30 (54%) (Table 1). Only 17 no-PP matches were identified for PP patients due to infrequent BALs. Similar proportion of patients in PP and no-PP groups had organisms identified from BAL (54% vs. 47%, p=0.65). Among PP patients with a detected organism, all (n=13) had subsequent changes in antibiotic regimen ≤72 hours after BAL; 10/13 (77%) had a change targeted to detected organism and 5/13 (39%) had antibiotic narrowing. Among PP patients with no detected organism, only 4/11 (36%) had antibiotic narrowing or maintenance off antibiotics. In all groups, average antibiotic use exceeded 70% of admission duration.Table 1. Patient characteristics and antibiotic management. Abbreviations: BAL - bronchoalveolar lavage ConclusionRapid, highly sensitive diagnostic tests have potential to guide clinical decisions and promote antibiotic stewardship among patients with severe viral pneumonia and suspected bacterial co-infection. In this descriptive analysis, antibiotic management did not differ significantly with use of PP. While most patients with detected organism on PP had targeted antibiotic changes, a negative PP did not appear to influence antibiotic narrowing. Larger studies and provider education are needed to evaluate potential of the PP for antibiotic stewardship. Disclosures Jason Zucker, MD, MS, Nothing to disclose Daniel A. Green, M.D., BioFire (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) Deborah Theodore, MD, BioFire Diagnostics (Other Financial or Material Support, Donation of testing materials to support investigator-initiated research)