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Geslain G, Cointe A, Naudin J, Dauger S, Poey N, Pages J, Le Roux E, Bonacorsi S. Diagnostic Accuracy of Blind Bronchial Sample Testing by BioFire Pneumonia plus Panel in Pediatric Intensive Care Unit Patients and Its Impact in Early Adaptation of Antimicrobial Therapy: A Prospective Observational Study. Pediatr Infect Dis J 2024; 43:725-730. [PMID: 38621162 DOI: 10.1097/inf.0000000000004349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Community-acquired and nosocomial lower-respiratory-tract infections in critically ill pediatric patients require early appropriate antibiotic therapy to optimize outcomes. Using blind bronchial samples, we assessed the diagnostic performance of the rapid-multiplex polymerase chain reaction (PCR) assay BioFire Pneumonia plus Panel vs. reference standard culturing with antimicrobial susceptibility testing. METHODS For this prospective observational study in a single pediatric intensive care unit, we included consecutive patients younger than 18 years admitted for suspected community-, hospital- or ventilator-associated pneumonia in 2021-2022. Sensitivity, specificity, positive predictive value and negative predictive value of the multiplex PCR assay were determined. The kappa coefficient was computed to assess agreement, and univariate analyses were done to identify factors associated with discrepancies between the 2 diagnostic methods. RESULTS Of the 36 included patients (median age, 1.4 years; interquartile range, 0.2-9.2), 41.7%, 27.8%, and 30.5% had community-, hospital- and ventilator-associated pneumonia, respectively. The overall κ was 0.74, indicating good agreement. Overall, the sensitivity of the multiplex PCR assay was 92% (95% CI: 77%-98%) and specificity 95% (95% CI: 92%-97%), with variations across microorganisms. The median time from sample collection to antimicrobial susceptibility test results was 3.9 (2.5-15) hours with the multiplex PCR assay and 60.5 (47.6-72.2) hours with the reference technique. CONCLUSION The BioFire Pneumonia plus Panel used to test blind bronchial samples had satisfactory diagnostic performance in critically ill pediatric patients. The rapid results provided by this test may improve the appropriateness of antimicrobial therapy and help minimize the use of antibiotics.
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Affiliation(s)
- Guillaume Geslain
- From the Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, IAME, INSERM UMR 1137, Paris, France
| | - Aurélie Cointe
- Paris Cité University, IAME, INSERM UMR 1137, Paris, France
- Department of Microbiology, Escherichia coli National Reference Center, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Jérôme Naudin
- From the Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Dauger
- From the Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, NeuroDiderot, INSERM UMR 1141, Paris, France
| | - Nora Poey
- Department of General Paediatrics, Paediatric Infectious Diseases and Internal Medicine, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Justine Pages
- Clinical Epidemiology Unit, INSERM CIC 1426, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Enora Le Roux
- Clinical Epidemiology Unit, INSERM CIC 1426, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Bonacorsi
- Paris Cité University, IAME, INSERM UMR 1137, Paris, France
- Department of Microbiology, Escherichia coli National Reference Center, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
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Martin M, Forveille S, Lascarrou JB, Seguin A, Canet E, Lemarié J, Agbakou M, Desmedt L, Blonz G, Zambon O, Corvec S, Le Thuaut A, Reignier J. Immediate vs. culture-initiated antibiotic therapy in suspected non-severe ventilator-associated pneumonia: a before-after study (DELAVAP). Ann Intensive Care 2024; 14:33. [PMID: 38411756 PMCID: PMC10897643 DOI: 10.1186/s13613-024-01243-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the leading nosocomial infection in critical care and is associated with adverse outcomes. When VAP is suspected, starting antibiotic therapy (AT) immediately after pulmonary sampling may expose uninfected patients to unnecessary treatment, whereas waiting for bacteriological confirmation may delay AT in infected patients. As no robust data exist to choose between these strategies, the decision must balance the pre-test diagnostic probability, clinical severity, and risk of antimicrobial resistance. The objective of this study in patients with suspected non-severe VAP was to compare immediate AT started after sampling to conservative AT upon receipt of positive microbiological results. The outcomes were antibiotic sparing, AT suitability, and patient outcomes. METHODS This single-center, before-after study included consecutive patients who underwent distal respiratory sampling for a first suspected non-severe VAP episode (no shock requiring vasopressor therapy or severe acute respiratory distress syndrome). AT was started immediately after sampling in 2019 and upon culture positivity in 2022 (conservative strategy). The primary outcome was the number of days alive without AT by day 28. The secondary outcomes were mechanical ventilation duration, day-28 mortality, and AT suitability (active necessary AT or spared AT). RESULTS The immediate and conservative strategies were applied in 44 and 43 patients, respectively. Conservative and immediate AT were associated with similar days alive without AT (median [interquartile range], 18.0 [0-21.0] vs. 16.0 [0-20.0], p = 0.50) and without broad-spectrum AT (p = 0.53) by day 28. AT was more often suitable in the conservative group (88.4% vs. 63.6%, p = 0.01), in which 27.9% of patients received no AT at all. No significant differences were found for mechanical ventilation duration (median [95%CI], 9.0 [6-19] vs. 9.0 [6-24] days, p = 0.65) or day-28 mortality (hazard ratio [95%CI], 0.85 [0.4-2.0], p = 0.71). CONCLUSION In patients with suspected non-severe VAP, waiting for microbiological confirmation was not associated with antibiotic sparing, compared to immediate AT. This result may be ascribable to low statistical power. AT suitability was better with the conservative strategy. None of the safety outcomes differed between groups. These findings would seem to allow a large, randomized trial comparing immediate and conservative AT strategies.
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Affiliation(s)
- Maëlle Martin
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France.
| | - Solène Forveille
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | | | - Amélie Seguin
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Emmanuel Canet
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Jérémie Lemarié
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Maïté Agbakou
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Luc Desmedt
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Gauthier Blonz
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Olivier Zambon
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Stéphane Corvec
- Nantes Université, CHU Nantes, Institut de Biologie des Hôpitaux de Nantes, Service de Bactériologie Et Des Contrôles Microbiologiques, Nantes, France
| | - Aurélie Le Thuaut
- Nantes Université, CHU Nantes, Plateforme de méthodologie et biostatistique, Direction de la recherche et de l'innovation, Nantes, France
| | - Jean Reignier
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Nantes, France
- Nantes Université, CHU Nantes, Médecine Intensive Réanimation, Movement - Interactions - Performance, MIP, UR 4334, Nantes, France
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de Roquetaillade C, Bredin S, Lascarrou JB, Soumagne T, Cojocaru M, Chousterman BG, Leclerc M, Gouhier A, Piton G, Pène F, Stoclin A, Llitjos JF. Timing and causes of death in severe COVID-19 patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:224. [PMID: 34193220 PMCID: PMC8243043 DOI: 10.1186/s13054-021-03639-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/12/2021] [Indexed: 01/08/2023]
Abstract
Background Previous studies reporting the causes of death in patients with severe COVID-19 have provided conflicting results. The objective of this study was to describe the causes and timing of death in patients with severe COVID-19 admitted to the intensive care unit (ICU). Methods We performed a retrospective study in eight ICUs across seven French hospitals. All consecutive adult patients (aged ≥ 18 years) admitted to the ICU with PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. The causes and timing of ICU deaths were reported based on medical records. Results From March 1, 2020, to April 28, 287 patients were admitted to the ICU for SARS-CoV-2 related acute respiratory failure. Among them, 93 patients died in the ICU (32%). COVID-19-related multiple organ dysfunction syndrome (MODS) was the leading cause of death (37%). Secondary infection-related MODS accounted for 26% of ICU deaths, with a majority of ventilator-associated pneumonia. Refractory hypoxemia/pulmonary fibrosis was responsible for death in 19% of the cases. Fatal ischemic events (venous or arterial) occurred in 13% of the cases. The median time from ICU admission to death was 15 days (25th–75th IQR, 7–27 days). COVID-19-related MODS had a median time from ICU admission to death of 14 days (25th–75th IQR: 7–19 days), while only one death had occurred during the first 3 days since ICU admission. Conclusions In our multicenter observational study, COVID-19-related MODS and secondary infections were the two leading causes of death, among severe COVID-19 patients admitted to the ICU.
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Affiliation(s)
- Charles de Roquetaillade
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP. Nord, Paris, France.,Inserm U942 MASCOT, Paris, France
| | - Swann Bredin
- Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris Centre, Paris, France
| | | | - Thibaud Soumagne
- Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France
| | - Mariana Cojocaru
- Surgical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris Centre, Paris, France
| | - Benjamin Glenn Chousterman
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP. Nord, Paris, France.,Inserm U942 MASCOT, Paris, France
| | - Maxime Leclerc
- Intensive Care Unit, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France
| | - Albin Gouhier
- Intensive Care Unit, Centre Hospitalier Intercommunal Alençon Mamers, Alençon, France
| | - Gaël Piton
- Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France
| | - Frédéric Pène
- Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris Centre, Paris, France
| | - Annabelle Stoclin
- Intensive Care Unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Llitjos JF, Bredin S, Lascarrou JB, Soumagne T, Cojocaru M, Leclerc M, Lepetit A, Gouhier A, Charpentier J, Piton G, Faron M, Stoclin A, Pène F. Increased susceptibility to intensive care unit-acquired pneumonia in severe COVID-19 patients: a multicentre retrospective cohort study. Ann Intensive Care 2021; 11:20. [PMID: 33512602 PMCID: PMC7844782 DOI: 10.1186/s13613-021-00812-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of this study is to determine whether severe COVID-19 patients harbour a higher risk of ICU-acquired pneumonia. METHODS This retrospective multicentre cohort study comprised all consecutive patients admitted to seven ICUs for severe COVID-19 pneumonia during the first COVID-19 surge in France. Inclusion criteria were laboratory-confirmed SARS-CoV-2 infection and requirement for invasive mechanical ventilation for 48 h or more. Control groups were two historical cohorts of mechanically ventilated patients admitted to the ICU for bacterial or non-SARS-CoV-2 viral pneumonia. The outcome of interest was the development of ICU-acquired pneumonia. The determinants of ICU-acquired pneumonia were investigated in a multivariate competing risk analysis. RESULT One hundred and seventy-six patients with severe SARS-CoV-2 pneumonia admitted to the ICU between March 1st and 30th June of 2020 were included into the study. Historical control groups comprised 435 patients with bacterial pneumonia and 48 ones with viral pneumonia. ICU-acquired pneumonia occurred in 52% of COVID-19 patients, whereas in 26% and 23% of patients with bacterial or viral pneumonia, respectively (p < 0.001). Times from initiation of mechanical ventilation to ICU-acquired pneumonia were similar across the three groups. In multivariate analysis, the risk of ICU-acquired pneumonia remained independently associated with underlying COVID-19 (SHR = 2.18; 95 CI 1.2-3.98, p = 0.011). CONCLUSION COVID-19 appears an independent risk factor of ICU-acquired pneumonia in mechanically ventilated patients with pneumonia. Whether this is driven by immunomodulatory properties by the SARS-CoV-2 or this is related to particular processes of care remains to be investigated.
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Affiliation(s)
- Jean-François Llitjos
- 3i Department, Team Pulmonary and Systemic Immune Responses During Acute and Chronic Bacterial Infections, Institut Cochin, INSERM U1016, CNRS UMR8104, Université de Paris, Paris, France.
- Intensive care unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - Swann Bredin
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Centre, Paris, France
| | | | - Thibaud Soumagne
- Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France
| | - Mariana Cojocaru
- Surgical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Centre, Paris, France
| | - Maxime Leclerc
- Intensive Care Unit, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France
| | - Arnaud Lepetit
- Intensive Care Unit, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France
| | - Albin Gouhier
- Intensive Care Unit, Centre Hospitalier Intercommunal Alençon Mamers, Alençon, France
| | - Julien Charpentier
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Centre, Paris, France
| | - Gaël Piton
- Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France
| | - Matthieu Faron
- Department of Biostatistics and Epidemiology, Inserm UNIT 1018 CESP Oncostat Team, Gustave Roussy Cancer Campus, Villejuif, France
| | - Annabelle Stoclin
- Intensive care unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Frédéric Pène
- 3i Department, Team Pulmonary and Systemic Immune Responses During Acute and Chronic Bacterial Infections, Institut Cochin, INSERM U1016, CNRS UMR8104, Université de Paris, Paris, France
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Centre, Paris, France
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