Neumonía en el paciente crítico: diagnóstico sindrómico rápido de PCR múltiple en un Hospital General de Agudos
Palabras clave:
diagnóstico rápido, neumonía, pcr, conducta terapéutica
Resumen
Está demostrado en diversos estudios que los avances en el diagnóstico microbiológico reduce el tiempo de entrega de resultados y posee un impacto clínico evidente. Hoy en día, las técnicas basadas en amplificación de ácidos nucleicos nos permiten hacer diagnóstico directamente de la muestra y sumar la posibilidad de detectar más de un agente. Esto impacta tanto en el control de la MMR como en el inicio de una terapéutica apropiada. La implementación de un sistema de PCR múltiple rápido para neumonía puede ser útil en áreas críticas donde son frecuentes las infecciones respiratorias agudas (IRA) y el tiempo es un condicionante del éxito terapéutico. El objetivo de nuestro proyecto fue evaluar la implementación del diagnóstico sindrómico rápido por PCR múltiple para neumonía en el manejo del tratamiento de IRA en una Unidad de Cuidados Intensivos. La conducta terapéutica fue la variable relevante. Este nuevo diagnóstico nos proporcionó una herramienta ágil, con un tiempo de respuesta de 3 a 4 horas. La ausencia o presencia de genes de resistencia y el microorganismo identificado, fue lo que condujo a la conducta terapéutica acertada en el 75% de los casos. Constituyó una herramienta importante para el control de la multirresistencia bacteriana y aumentó la oportunidad de éxito terapéutico.
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(1) Vila J, Gómez MD, Salavert M, Bosch J. Methods of rapid diagnosis in clinical microbiology: Clinical needs. Enferm Infecc Microbiol Clin. 2017 Jan 35(1):41–46
(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/
(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/
Publicado
2023-11-21
Cómo citar
Scorzato, L., Pinca, N., Montoto, M., Madonni, P., & Grignet, R. (2023). Neumonía en el paciente crítico: diagnóstico sindrómico rápido de PCR múltiple en un Hospital General de Agudos. Actualizaciones En Sida E Infectología, 31(113). https://doi.org/10.52226/revista.v31i113.204
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