快速多重聚合酶链反应检测呼吸道病原体对儿科急诊科儿童社区获得性肺炎管理的影响。一项随机对照试验，即肺炎急性护理优化（OPTIPAC）研究。

Impact of respiratory pathogens detection by a rapid multiplex polymerase chain reaction assay on the management of community-acquired pneumonia for children at the paediatric emergency department. A randomized controlled trial, the Optimization of Pneumonia Acute Care (OPTIPAC) study.

作者信息

Cantais Aymeric, Pillet Sylvie, Rigaill Josselin, Angoulvant François, Gras-Le-Guen Christele, Cros Pierrick, Thuiller Charlotte, Molly Claudine, Tripodi Louise, Desbree Aurélie, Annino Nadine, Verhoeven Paul, Carricajo Anne, Bourlet Thomas, Chapelle Céline, Claudet Isabelle, Garcin Arnauld, Izopet Jacques, Mory Olivier, Pozzetto Bruno

机构信息

Department of Paediatric Emergencies, Hospital University of Saint-Etienne, Saint-Etienne, France; Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1111, CNRS, UMR5308, ENS Lyon, Université Jean Monnet de Saint-Etienne, Lyon, France.

Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1111, CNRS, UMR5308, ENS Lyon, Université Jean Monnet de Saint-Etienne, Lyon, France; Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France.

出版信息

Clin Microbiol Infect. 2025 Jan;31(1):64-70. doi: 10.1016/j.cmi.2024.08.001. Epub 2024 Aug 5.

DOI:10.1016/j.cmi.2024.08.001

PMID:39111697

Abstract

OBJECTIVES

The pathogen of community-acquired pneumonia (CAP) in children is typically uncertain during initial treatment, leading to systematic empiric antibiotic use. This study investigates if having rapid multiplex PCR results in the emergency department (ED) improves empiric treatment.

METHODS

OPTIPAC, a French multicentre study (2016-2018), enrolled patients consulting for CAP at the paediatric ED in 11 centres. Patients were randomized to either receive a multiplex PCR test plus usual care or usual care alone and followed for 15 days. The primary outcome was the appropriateness of initial antimicrobial management, determined by a blinded committee.

RESULTS

Of the 499 randomized patients, 248 were tested with the multiplex PCR. Appropriateness of the antibiotic treatment was higher in the PCR group (168/245, 68.6% vs. 120/249, 48.2%; Relative risk 1.42 [1.22-1.66]; p < 0.0001), chiefly by reducing unnecessary antibiotics in viral pneumonia (RR 3.29 [2.20-4.90]). No adverse events were identified.

DISCUSSION

The multiplex PCR assay result at the ED improves paediatric CAP's antimicrobial stewardship, by both reducing antibiotic prescriptions and enhancing treatment appropriateness.

摘要

目的

儿童社区获得性肺炎（CAP）在初始治疗时病原体通常不明，导致系统性经验性使用抗生素。本研究调查在急诊科获得快速多重聚合酶链反应（PCR）结果是否能改善经验性治疗。

方法

OPTIPAC是一项法国多中心研究（2016 - 2018年），纳入了11个中心儿科急诊科因CAP就诊的患者。患者被随机分为两组，一组接受多重PCR检测加常规护理，另一组仅接受常规护理，并随访15天。主要结局是由一个盲法委员会确定的初始抗菌管理的恰当性。

结果

在499例随机分组的患者中，248例接受了多重PCR检测。PCR组抗生素治疗的恰当性更高（168/245，68.6% 对比120/249，48.2%；相对风险1.42 [1.22 - 1.66]；p < 0.0001），主要是通过减少病毒性肺炎中不必要的抗生素使用（相对风险3.29 [2.20 - 4.90]）。未发现不良事件。