对受保护的望远镜导管样本进行多重聚合酶链反应在急性呼吸窘迫综合征患者抗菌治疗早期调整中的应用潜力
Potential of Multiplex Polymerase Chain Reaction Performed on Protected Telescope Catheter Samples for Early Adaptation of Antimicrobial Therapy in ARDS Patients.
作者信息
Razazi Keyvan, Delamaire Flora, Fihman Vincent, Boujelben Mohamed Ahmed, Mongardon Nicolas, Gendreau Ségolène, de Roux Quentin, de Prost Nicolas, Carteaux Guillaume, Woerther Paul-Louis, Mekontso Dessap Armand
机构信息
AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, CHU Henri Mondor, 51, Av. de Lattre de Tassigny, CEDEX, 94010 Créteil, France.
Faculté de Médecine de Créteil, IMRB, GRC CARMAS, Université Paris Est Créteil, 94010 Créteil, France.
出版信息
J Clin Med. 2022 Jul 27;11(15):4366. doi: 10.3390/jcm11154366.
BACKGROUND
Diagnosis of co/superinfection in patients with Acute Respiratory Distress Syndrome (ARDS) is challenging. The FilmArray Pneumonia plus Panel (bioMérieux, France), a new rapid multiplex Polymerase Chain Reaction (mPCR), has never been assessed on a blinded protected telescope catheter (PTC) samples, a very common diagnostic tool in patients under mechanical ventilation. We evaluated the performance of mPCR on PTC samples compared with conventional culture and its impact on antibiotic stewardship.
METHODS
Observational study in two intensive care units, conducted between March and July 2020, during the first wave of the COVID-19 pandemic in France.
RESULTS
We performed 125 mPCR on blinded PTC samples of 95 ARDS patients, including 73 (77%) SARS-CoV-2 cases and 28 (29%) requiring extracorporeal membrane oxygenation. Respiratory samples were drawn from mechanically ventilated patients either just after intubation ( = 48; 38%) or later for suspected ventilator-associated pneumonia (VAP) ( = 77; 62%). The sensitivity, specificity, positive, and negative predictive values of mPCR were 93% (95% CI 84-100), 99% (95% CI 99-100), 68% (95% CI 54-83), and 100% (95% CI 100-100), respectively. The overall coefficient of agreement between mPCR and standard culture was 0.80 (95% CI 0.68-0.89). Intensivists changed empirical antimicrobial therapy in only 14% (18/125) of cases. No new antibiotic was initiated in more than half of the CAP/HAP pneumonia-suspected cases ( = 29; 60%) and in more than one-third of those suspected to have VAP without affecting or delaying their antimicrobial therapy.
CONCLUSIONS
Rapid mPCR was feasible on blinded PTC with good sensitivity and specificity. New antibiotics were not initiated in more than half of patients and more than one-third of VAP-suspected cases. Further studies are needed to assess mPCR potential in improving antibiotic stewardship.
背景
急性呼吸窘迫综合征（ARDS）患者合并/重叠感染的诊断具有挑战性。FilmArray肺炎加检测板（法国生物梅里埃公司）是一种新型快速多重聚合酶链反应（mPCR），从未在盲法保护套管针（PTC）样本上进行过评估，而PTC是机械通气患者常用的诊断工具。我们评估了mPCR在PTC样本上相对于传统培养的性能及其对抗生素管理的影响。
方法
于2020年3月至7月在法国第一波新冠疫情期间，在两个重症监护病房进行观察性研究。
结果
我们对95例ARDS患者的盲法PTC样本进行了125次mPCR检测，其中包括73例（77%）新冠病毒2型病例，28例（29%）需要体外膜肺氧合。呼吸样本取自机械通气患者，要么在插管后立即采集（n = 48；38%），要么后来因怀疑呼吸机相关性肺炎（VAP）而采集（n = 77；62%）。mPCR的敏感性、特异性、阳性预测值和阴性预测值分别为93%（95%CI 84 - 100）、99%（95%CI 99 - 100）、68%（95%CI 54 - 83）和100%（95%CI 100 - 100）。mPCR与标准培养之间的总体一致性系数为0.80（95%CI 0.68 - 0.89）。重症监护医生仅在14%（18/125）的病例中改变了经验性抗菌治疗。超过一半的疑似社区获得性肺炎/医院获得性肺炎病例（n = 29；60%）以及超过三分之一的疑似VAP病例在不影响或不延迟其抗菌治疗的情况下未启用新的抗生素。
结论
快速mPCR在盲法PTC上可行，具有良好的敏感性和特异性。超过一半的患者以及超过三分之一的疑似VAP病例未启用新的抗生素。需要进一步研究来评估mPCR在改善抗生素管理方面的潜力。
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