Abstract
BackgroundEarly appropriate antibiotic therapy reduces morbidity and mortality of severe pneumonia. However, the emergence of bacterial resistance requires the earliest use of antibiotics with the narrowest possible spectrum. The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR (M-PCR) system detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 h. We assessed the performance and the potential impact of the M-PCR on the antibiotic therapy of ICU patients.MethodsIn this prospective study, we performed a M-PCR on bronchoalveolar lavage (BAL) or plugged telescoping catheter (PTC) samples of patients with ventilated HAP or VAP with Gram-negative bacilli or clustered Gram-positive cocci. This study was conducted in 3 ICUs in a French academic hospital: the medical and infectious diseases ICU, the surgical ICU, and the cardio-surgical ICU. A multidisciplinary expert panel simulated the antibiotic changes they would have made if the M-PCR results had been available.ResultsWe analyzed 95 clinical samples of ventilated HAP or VAP (72 BAL and 23 PTC) from 85 patients (62 males, median age 64 years). The median turnaround time of the M-PCR was 4.6 h (IQR 4.4–5). A total of 90/112 bacteria were detected by the M-PCR system with a global sensitivity of 80% (95% CI, 73–88%) and specificity of 99% (95% CI 99–100). The sensitivity was better for Gram-negative bacteria (90%) than for Gram-positive cocci (62%) (p = 0.005). Moreover, 5/8 extended-spectrum beta-lactamases (CTX-M gene) and 4/4 carbapenemases genes (3 NDM, one oxa-48) were detected. The M-PCR could have led to the earlier initiation of an effective antibiotic in 20/95 patients (21%) and to early de-escalation in 37 patients (39%) but could also have led to one (1%) inadequate antimicrobial therapy. Among 17 empiric antibiotic treatments with carbapenems, 10 could have been de-escalated in the following hours according to the M-PCR results. The M-PCR also led to 2 unexpected diagnosis of severe legionellosis confirmed by culture methods.ConclusionsOur results suggest that the use of a M-PCR system for respiratory samples of patients with VAP and ventilated HAP could improve empirical antimicrobial therapy and reduce the use of broad-spectrum antibiotics.
Highlights
Hospital-acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) are the most common healthcare-associated infections in adults and are the leading causes of death in critical care [1, 2]
Our results suggest that the use of a multiplex PCR (M-PCR) system for respiratory samples of patients with VAP and ventilated HAP could improve empirical antimicrobial therapy and reduce the use of broad-spectrum antibiotics
We evaluated the diagnostic performance of the Unyvero HPN test compared to standard microbiological tests and the potential impact of its results on early adaptation of antimicrobial therapy in ICU patients with suspected ventilated HAP or VAP
Summary
Hospital-acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) are the most common healthcare-associated infections in adults and are the leading causes of death in critical care [1, 2]. HAP and VAP are associated with a longer duration of mechanical ventilation, ICU stay, hospitalization, and increased healthcare cost [3]. They are associated with an excess of morbidity and mortality [4]. International guidelines advocate the empirical use of broad-spectrum antibiotics including carbapenems in the treatment of VAP caused by Gram-negative bacilli in the case of prior antibiotic therapy, in patients colonized by multidrug-resistant bacteria (MDR), or in any late-onset VAP (more than 5 days after the beginning of mechanical ventilation) [1, 4]. We assessed the performance and the potential impact of the M-PCR on the antibiotic therapy of ICU patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
