Pneumologie 2022; 76(S 01): S64
DOI: 10.1055/s-0042-1747835
Abstracts

Fast multiplex assay of Gram-negative rods for antibiotic stewardship in patients hospitalised with pneumonia – a randomised controlled trial

A Darie
1   University Hospital Basel; Clinic of Respiratory Medicine and Pulmonary Cell Research
,
N Khanna
2   Infectious Diseases & Hospital Epidemiology, Department of Acute Medicine, University Hospital Basel, Switzerland
,
K Jahn
3   Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
,
M Osthoff
4   Division of Internal Medicine, University Hospital Basel, Switzerland
,
S Bassetti
4   Division of Internal Medicine, University Hospital Basel, Switzerland
,
M Osthoff
3   Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
,
D M Schumann
3   Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
,
W C Albrich
5   Department of Infectious Diseases, Kantonsspital St. Gallen, Switzerland
,
H Hirsch
6   Department of Microbiology and Clinical Virology, University Hospital Basel, Switzerland
,
M Brutsche
7   Clinic of Pulmonary Medicine, Kantonsspital St. Gallen, Switzerland
,
L Grize
3   Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
,
M Tamm
3   Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
,
D Stolz
8   Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland; Clinic of Respiratory Medicine, University of Freiburg, Germany
› Author Affiliations
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    In recent years, polymerase chain reaction (PCR) diagnostic methods have emerged as the new standard in viral infections. The aim of this study was to determine whether multiplex bacterial PCR of bronchoalveolar lavage (BAL) fluid improves antibiotic stewardship in hospitalised patients with pneumonia at risk of Gram-negative bacterial infection.

    In this investigator-initiated and -driven multicentre, randomised controlled trial, hospitalised patients with pneumonia at risk of Gram-negative rods were randomly assigned (1:1) to BAL examination by conventional microbiology together with multiplex bacterial PCR panel assay testing or by conventional microbiology alone (the control group). The primary outcome was duration of inappropriate antibiotic therapy. Physicians attending the patients randomised to the PCR group received a recommendation for antibiotic adjustment within 5 hours of bronchoscopy.

    A total of 208 patients were randomised to either the PCR group (n=100) or the control group (n=108). The durations of prescribed and administered inappropriate antibiotic therapy were significantly shorter in the PCR group (70.0 hours vs 110.4 hours, P=0.0016 and 47.1 hours vs 85.7 hours, P<0.0001) than in the control group, which translates into a reduction in the duration of inappropriate antibiotic therapy by 45%. Patients in the PCR group had a higher probability of freedom from inappropriate therapy than patients in the control group (HR 3.16, P< 0.0001). The antibiotic therapy in the PCR group was 22.5% shorter than in the control group (127.2 hours vs 161.3 hours, p=0.054). There were no significant differences in time to clinical stability (2.5 days vs 2.4 days P=0.60), length of stay (14.4 days vs 16.0 days, P=0.29), ICU admission (21.0% vs 19.4%, P=0.86) or mortality (8.0% vs 10.2%, P=0.58) between the randomised groups.

    Multiplex bacterial PCR examination of BAL efficiently and safely decreases the duration of inappropriate antibiotic therapy of hospitalised patients with pneumonia and at risk of Gram-negative rods infection.


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    Publication History

    Article published online:
    11 May 2022

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