The Impact of Pneumonia PCR Panel Testing in the PICU: A Quality Improvement Study

Yaron Fireizen; Christopher J. Babbitt; Susan Adams; Tricia Morphew; Emanuel T. Ferro; Inderpal Randhawa

doi:10.1055/s-0042-1743178

Journal of Pediatric Intensive Care, Inhaltsverzeichnis

J Pediatr Intensive Care 2024; 13(04): 356-363
DOI: 10.1055/s-0042-1743178

Original Article

The Impact of Pneumonia PCR Panel Testing in the PICU: A Quality Improvement Study

Yaron Fireizen

¹Department of Pediatric Pulmonology, Miller Children's and Women's Hospital of Long Beach, University of California, Irvine School of Medicine, Irvine, California, United States

,

Christopher J. Babbitt

²Department of Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States

,

Susan Adams

³Department of Pediatric Pharmacy, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, United States

,

Tricia Morphew

⁴Morphew Consulting LLC, Bothell, Washington, United States

⁵MemorialCare Health System, Fountain Valley, California, United States

,

Emanuel T. Ferro

⁶Department of Pathology, Long Beach Memorial Medical Center, Long Beach, California, United States

,

Inderpal Randhawa

¹Department of Pediatric Pulmonology, Miller Children's and Women's Hospital of Long Beach, University of California, Irvine School of Medicine, Irvine, California, United States

› Institutsangaben

Abstract

Inappropriate antibiotic usage can contribute to the promotion of resistant bacteria. In an effort to reduce antibiotic length of therapy (LOT), we initiated a performance improvement project utilizing pneumonia polymerase chain reaction (PCR) testing in ventilated pediatric intensive care unit (PICU) patients suspected of tracheitis or pneumonia. This was a single-center cohort intervention study that compared pre- and postimplementation patients. The intervention was the use of a pneumonia PCR panel on all PICU patients undergoing an evaluation for acute tracheitis or pneumonia during the postimplementation period. The inclusion criteria were either acute or acute on chronic respiratory failure. After an 8-month period, the charts were reviewed from both cohorts and baseline data, and outcome data were compared by statistical analysis. A total of 41 preimplementation and 30 postimplementation patients were compared, and no baseline differences were found except postimplementation patients being slightly older (133 vs. 56 months, p-value = 0.040). Analysis of the primary outcome measures found that the time to identification of organism (5 vs. 67 hours) and LOT (5 vs. 9 days, p < 0.001) were shorter in postimplementation patients compared with preimplementation patients. Antibiotics were changed based on the results of the pneumonia PCR on 18 of 30 patients (60%). There was no difference in ventilator-free days, PICU length of stay, or mortality. In conclusion, pneumonia PCR panel testing leads to more rapid results and was associated with reduced antibiotic LOT.

Keywords

antibiotics - pneumonia - ventilator

Volltext

Referenzen

References
1 Centers for Disease Control and Prevention (CDC). Core elements of hospital antibiotic stewardship programs. Atlanta, GA, US Department of Health and Human Services, CDC; 2014 . Accessed on June 15, 2021 at: https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
2 Zilahi G, McMahon MA, Povoa P, Martin-Loeches I. Duration of antibiotic therapy in the intensive care unit. J Thorac Dis 2016; 8 (12) 3774-3780
3 Adams SM, Ngo L, Morphew T, Babbitt CJ. Does an antimicrobial time-out impact the duration of therapy of antimicrobials in the PICU?. Pediatr Crit Care Med 2019; 20 (06) 560-567
4 Sellers LA, Fitton KM, Segovia MF, Forehand CC, Dobbin KK, Newsome AS. Time to blood, respiratory and urine culture positivity in the intensive care unit: implications for de-escalation. SAGE Open Med 2021;9:20503121211040702
5 Buccambuso M, Edwards T, Hockin M. et al. Analytical reactivity of the FilmArray pneumonia panel plus for identiﬁcation of viruses, bacteria and antimicrobial resistance genes from lower respiratory tract specimens. In: 28th European Congress of clinical Microbiology and Infectious Diseases (ECCMID). Madrid, Spain; April 21, 2018, P0571
6 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; 52 (06) 920-928
7 Shook J. Managing to Learn: Using the A3 Management Process to Solve Problems, Gain Agreement, Mentor and Lead. Cambridge, MA: Lean Enterprise Institute; 2008
8 Wetzel RC, Sachedeva R, Rice TB. Are all ICUs the same?. Paediatr Anaesth 2011; 21 (07) 787-793
9 Pollack MM, Holubkov R, Funai T. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. The pediatric risk of mortality score: update 2015. Pediatr Crit Care Med 2016; 17 (01) 2-9
10 Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05) 428-439
11 Williams DJ, Zhu Y, Grijalva CG. et al. Predicting severe pneumonia outcomes in children. Pediatrics 2016; 138 (04) e2016-e1019
12 Foschi C, Zignoli A, Gaibani P. et al. Respiratory bacterial co-infections in intensive care unit-hospitalized COVID-19 patients: conventional culture vs BioFire FilmArray pneumonia plus panel. J Microbiol Methods 2021; 186: 106259
13 Bradley JS, Byington CL, Shah SS. et al; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53 (07) 617-630
14 Willson DF, Hoot M, Khemani R. et al; Ventilator-Associated INfection (VAIN) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigator's (PALISI) Network. Pediatric ventilator-associated infections: the Ventilator-Associated INfection study. Pediatr Crit Care Med 2017; 18 (01) e24-e34
15 Karsies T, Tarquinio K, Shein SL. et al; Pediatric Acute Lung Injury and Sepsis Investigator's (PALISI) Network. Compliance with an antibiotic guidelines for suspected ventilator-associated infection: the Ventilator-Associated INfection (VAIN2) Study. Pediatr Crit Care Med 2021; 22 (10) 859-869
16 Huang HS, Tsai CL, Chang J, Hsu TC, Lin S, Lee CC. Multiplex PCR system for the rapid diagnosis of respiratory virus infection: systematic review and meta-analysis. Clin Microbiol Infect 2018; 24 (10) 1055-1063
17 Li J, Tao Y, Tang M. et al. Rapid detection of respiratory organisms with the FilmArray respiratory panel in a large children's hospital in China. BMC Infect Dis 2018; 18 (01) 510
18 Yoshida K, Hatachi T, Okamoto Y. et al. Application of multiplex polymerase chain reaction for pathogen identification and antibiotic use in children with respiratory infections in a PICU. Pediatr Crit Care Med 2021; 22 (12) e644-e648
19 Rand KH, Beal SG, Cherabuddi K. et al. Performance of a semiquantitative multiplex bacterial and viral PCR panel compared with standard microbiological laboratory results: 396 patients studied with the Biofire Pneumonia Panel. Open Forum Infect Dis 2020; 8 (01) a560
20 Murphy CN, Fowler R, Balada-Llasat JM. et al. Multicenter evaluation of the Biofire® Filmarray® Pneumonia/Pneumonia Plus Panel for the detection and quantification of agents of lower respiratory tract infection. J Clin Microbiol 2020; 58 (07) e00128-e20
21 Buchan BW, Windham S, Balada-Llasat JM. et al. Practical comparison of the BioFire® FilmArray® Pneumonia Panel to routine diagnostic methods and potential impact on antimicrobial stewardship in adult hospitalized patients with lower respiratory tract infections. J Clin Microbiol 2020; 58 (07) e00135-e20
22 Webber DM, Wallace MA, Burnham CA, Anderson NW. Evaluation of the BioFire® FilmArray® Pneumonia Panel for detection of viral and bacterial pathogens in lower respiratory tract specimens in the setting of a tertiary care academic medical center. J Clin Microbiol 2020; 58 (07) e00343-e20
23 Rand KH, Beal SG, Cherabuddi K. et al. Relationship of multiplex molecular pneumonia panel results with hospital outcomes and clinical variables. Open Forum Infect Dis 2021; 8 (08) b368
24 Clinical Pulmonary Infection Score (CPIS) MDApp. Accessed October 2021 at: https://www.mdapp.co/clinical-pulmonary-infection-score-cpis-calculator-236/