Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Education, China Medical University Hospital, Taichung, Taiwan.
J Microbiol Immunol Infect. 2024 Jun;57(3):480-489. doi: 10.1016/j.jmii.2024.02.010. Epub 2024 Mar 6.
The optimal timing for applying the BioFire FilmArray Pneumonia Panel (FAPP) in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) remains undefined, and there are limited data on its impact on antimicrobial stewardship.
This retrospective study was conducted at a referral hospital in Taiwan from November 2019 to October 2022. Adult ICU patients with HAP/VAP who underwent FAPP testing were enrolled. Patient data, FAPP results, conventional microbiological testing results, and the real-world impact of FAPP results on antimicrobial therapy adjustments were assessed. Logistic regression was used to determine the predictive factors for bacterial detection by FAPP.
Among 592 respiratory specimens, including 564 (95.3%) endotracheal aspirate specimens, 19 (3.2%) expectorated sputum specimens and 9 (1.5%) bronchoalveolar lavage specimens, from 467 patients with HAP/VAP, FAPP testing yielded 368 (62.2%) positive results. Independent predictors for positive bacterial detection by FAPP included prolonged hospital stay (odds ratio [OR], 3.14), recent admissions (OR, 1.59), elevated C-reactive protein levels (OR, 1.85), Acute Physiology and Chronic Health Evaluation II scores (OR, 1.58), and septic shock (OR, 1.79). Approximately 50% of antimicrobial therapy for infections caused by Gram-negative bacteria and 58.4% for Gram-positive bacteria were adjusted or confirmed after obtaining FAPP results.
This study identified several factors predicting bacterial detection by FAPP in critically ill patients with HAP/VAP. More than 50% real-world clinical practices were adjusted or confirmed based on the FAPP results. Clinical algorithms for the use of FAPP and antimicrobial stewardship guidelines may further enhance its benefits.
在重症监护病房（ICU）中，医院获得性肺炎（HAP）或呼吸机相关性肺炎（VAP）患者应用 BioFire FilmArray Pneumonia Panel（FAPP）的最佳时机仍未确定，关于其对抗菌药物管理的影响的数据也有限。
本研究为回顾性研究，在台湾的一家转诊医院进行，时间为 2019 年 11 月至 2022 年 10 月。纳入接受 FAPP 检测的 HAP/VAP 成年 ICU 患者。评估患者数据、FAPP 结果、常规微生物检测结果以及 FAPP 结果对抗菌治疗调整的实际影响。使用逻辑回归确定 FAPP 检测细菌的预测因素。
在 467 例 HAP/VAP 患者的 592 份呼吸道标本中，包括 564 份（95.3%）气管内吸出物标本、19 份（3.2%）咳出痰标本和 9 份（1.5%）支气管肺泡灌洗液标本，FAPP 检测结果 368 份（62.2%）为阳性。FAPP 检测阳性的独立预测因素包括住院时间延长（比值比 [OR]，3.14）、近期入院（OR，1.59）、C 反应蛋白水平升高（OR，1.85）、急性生理学和慢性健康评估 II 评分（OR，1.58）和感染性休克（OR，1.79）。获得 FAPP 结果后，约 50%的革兰氏阴性菌感染和 58.4%的革兰氏阳性菌感染的抗菌治疗得到调整或确认。
本研究确定了几个预测 HAP/VAP 危重症患者 FAPP 检测细菌的因素。超过 50%的实际临床实践基于 FAPP 结果进行了调整或确认。FAPP 使用的临床算法和抗菌药物管理指南可能会进一步提高其获益。
