Pneumonia in the critically ill patient: rapid syndromic diagnosis by multiplex PCR in a General Hospital for Acute Care
Keywords:
rapid diagnosis, pneumonia, pcr, therapeutic behavior
Abstract
It has been shown in various studies that advances in microbiological diagnosis reduce the delivery time of results and have an evident clinical impact. Today, techniques based on nucleic acid amplification allow us to diagnose directly from the sample and add the possibility of detecting more than one agent. This impacts both the control of MMR and the initiation of appropriate therapy. The implementation of a rapid multiplex PCR system for pneumonia can be useful in critical areas where acute respiratory infections (ARI) are frequent and time is a determining factor for therapeutic success. The objective of our project was to evaluate the implementation of rapid syndromic diagnosis by multiple PCR for pneumonia in the management of ARI treatment in an Intensive Care Unit. The therapeutic behavior was the relevant variable. This new diagnosis provided us with an agile tool, with a response time of 3 to 4 hours. The absence or presence of resistance genes and the identified microorganism was what led to the correct therapeutic approach in 75% of the cases. It constituted an important tool for the control of bacterial multiresistance and increased the opportunity for therapeutic success.
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References
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(2) Poole S, Clark TW. Rapid syndromic molecular testing in pneumonia: The current landscape and future potential. J Infect. 2020 Jan;80(1):1-7.
(3) Fleming V, Buck B, Nix N, Kumar P, Southwood R. Community-acquired pneumonia with risk for drug-resistant pathogens. South Med J. 2013 Mar;106(3):209-16.
(4) Maataoui N, Chemali L, Patrier J, Tran Dinh A, Le Fèvre L, Lortat-Jacob B, et al. Impact of rapid multiplex PCR on management of antibiotic therapy in COVID-19-positive patients hospitalized in intensive care unit. Eur J Clin Microbiol Infect Dis. 2021 Oct;40(10):2227-2234.
(5) Hanson KE, Azar MM, Banerjee R, Chou A, Colgrove RC, Ginocchio CC, et al. Molecular Testing for Acute Respiratory Tract Infections: Clinical and Diagnostic Recommendations From the IDSA's Diagnostics Committee. Clin Infect Dis. 2020 Dec 17;71(10):2744-2751.
(6) Perez KK, Olsen RJ, Musick WL, Cernoch PL, Davis JR, Peterson LE, et al. Integra-
ting rapid pathogen identification and antimicrobial stewardship significantly decreases hospital costs. Arch Pathol Lab Med. 2013;137:1247–54.
(7) Posteraro B, Cortazzo V, Liotti FM, Menchinelli G, Ippoliti C, Vargas J, et al. Diagnosis and Treatment of Bacterial Pneumonia in Critically Ill Patients with COVID-19 Using a Multiplex PCR Assay: A Large Italian Hospital’s Five-Month Experience. Microbiol Spectr. 2021 Nov 9:e00695-21.
(8) Kollef MH, Burnham CD. Ventilator-Associated Pneumonia: The Role of Emerging Diagnostic Technologies. Semin Respir Crit Care Med. 2017 Jun;38(3):253-263.
(9) Pickens C, Wunderink RG, Qi C, Mopuru H, Donnelly H, Powell K, Sims MD. A multiplex polymerase chain reaction assay for antibiotic stewardship in suspected pneumonia. Diagn Microbiol Infect Dis. 2020 Dec;98(4):115179.
(10) Ogawa H, Kitsios GD, Iwata M, Terasawa T. Sputum Gram Stain for Bacterial Pathogen Diagnosis in Community-acquired Pneumonia: A Systematic Review and Bayesian Meta-analysis of Diagnostic Accuracy and Yield. Clin Infect Dis. 2020 Jul 27;71(3):499-513.
(11) Holter JC, Müller F ,Bjørang O, Samdal HH ,Marthinsen JB, Jenum PA, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis. 2015 Feb 15: 15-64
(12) Lee SH, Ruan SY, Pan SC, Lee TF, Chien JY, Hsueh PR. Performance of a multiplex PCR pneumonia panel for the identification of respiratory pathogens and the main determinants of resistance from the lower respiratory tract specimens of adult patients in intensive care units. J Microbiol Immunol Infect. 2019 Dec;52(6):920-928.
(13) Chaïbi K, Péan de Ponfilly G, Dortet L, Zahar JR, Pilmis B. Empiric Treatment in HAP/VAP: "Don't You Want to Take a Leap of Faith?". Antibiotics (Basel). 2022 Mar 8;11(3):359.
(14) Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67.
(15) Erich BJ, Kilic A, Palavecino E, Williamson J, Johnson J, Ohl C, Luther V, Beardsley J. Evaluation of the Potential Impact of a Multiplex Rapid Diagnostic Panel in Critically Ill Patients With Hospital-Acquired Pneumonia. Cureus. 2022 Jan 29;14(1):e21716.
(16) High, J., Enne, V.I., Barber, J.A. et al. INHALE: the impact of using FilmArray Pneumonia Panel molecular diagnostics for hospital-acquired and ventilator-associated pneumonia on antimicrobial stewardship and patient outcomes in UK Critical Care—study protocol for a multicentre randomised controlled trial. Trials 2021 Oct; 22 (680)
(17) Yoo IY, Huh K, Shim HJ, Yun SA, Chung YN, Kang OK, et al. Evaluation of the BioFire FilmArray Pneumonia Panel for rapid detection of respiratory bacterial pathogens and antibiotic resistance genes in sputum and endotracheal aspirate specimens. Int J Infect Dis. 2020 Jun;95:326-331.
(18) Pugh R, Grant C, Cooke RPD, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults.
Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD007577.
(19) Poole S, Tanner AR, Naidu VV, Borca F, Phan H, Saeed K, Grocott MPW, Dushianthan A, Moyses H, Clark TW. Molecular point-of-care testing for lower respiratory tract pathogens improves safe antibiotic de-escalation in patients with pneumonia in the ICU: Results of a randomised controlled trial. J Infect. 2022 Dec;85(6):625-633
(20) Peiffer-Smadja N, Bouadma L, Mathy V, Allouche K, Patrier J, Reboul M, et al. Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia. Crit Care. 2020 Jun 19;24(1):366.
(21) Shebl E, Gulick PG. Nosocomial Pneumonia. 2022 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30571062.
https://www.ncbi.nlm.nih.gov/books/NBK535441/
(22) Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia. Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 63(5):575-82.
(23) Murray P, Washington J. Microscopic and bacteriologic analysis of expectorated sputum. Mayo Clin Proc. 1975;50(6):339–44.
(24) Soloaga R, Barcán L, Bettiol M., Carrión N, Cornistein W, De Cristofano A, et al. Estudio multicéntrico argentino sobre la utilidad del panel de neumonía de FilmArray®. Acta Bioquímica Clínica Latinoamericana 2021; 55(3), 347-355.
(25) Lopardo H, Hernández C, Soloaga R. Diagnóstico microbiológico de las infecciones respiratorias. Apuntes de laboratorio. Buenos Aires: Laboratorios Britania; 1999.
(26) Miembros del 21.º Comité de Expertos OMS. Selección y Uso de Medicamentos Esenciales –se celebró del 27 al 31 de marzo de 2017 en la sede de la OMS. Comunicado de prensa: 6 de junio de 2017 http://www.who.int/mediacentre/news/releases/2017/essential-medicines-list/es/
Published
2023-11-21
How to Cite
Scorzato, L., Pinca, N., Montoto, M., Madonni, P., & Grignet, R. (2023). Pneumonia in the critically ill patient: rapid syndromic diagnosis by multiplex PCR in a General Hospital for Acute Care. Actualizaciones En Sida E Infectología, 31(113). https://doi.org/10.52226/revista.v31i113.204
Section
Brief communication
