Bhattacharyya Mahuya, Todi Subhash, Saha Ananya
Department of Critical Care Medicine, Advanced Medical Research Institute (AMRI) Hospitals, Dhakuria, IND.
Department of Clinical Pharmacy, Advanced Medical Research Institute (AMRI) Hospitals, Dhakuria, IND.
Cureus. 2025 Apr 2;17(4):e81620. doi: 10.7759/cureus.81620. eCollection 2025 Apr.
This study examined whether the use of the multiplex PCR (BioFire-FilmArray [bioMérieux, Marcy-l'Étoile, France]) (BF) technique reduced or optimized antibiotic use in patients admitted to the intensive care unit (ICU) with respiratory sepsis.
This retrospective observational study included adult patients with pulmonary sepsis admitted to the ICU, where the BF test was performed using lower respiratory samples. The primary outcome measure was any appropriate antibiotic change guided by BF within 24 hours of sending samples. Hospital mortality and length of stay (LOS) were compared between the two groups: the group in which antibiotics were appropriately changed within 24 hours of sending samples for BF and the group in which they were not.
A total of 117 patients with community- and hospital-acquired respiratory sepsis were included in this study. The mean APACHE IV score was 70.5±27.2, and 34 (29.1%) patients were in shock. BF was negative in 31 samples (26.5%), whereas culture was negative in 63 samples (53.8%). BF-guided de-escalation, escalation, and no change in antibiotics were indicated in 62 episodes (53%), 41 episodes (35%), and 14 episodes (11.9%), respectively. However, these changes were achieved in 15 episodes (24.2%), 40 episodes (97.6%), and 14 episodes (100%), respectively (p<0.0001). Hospital mortality and LOS were lower in cases where antibiotic alteration was indicated and performed, compared to cases where it was not (nonsignificant).
The identification of the causative agent using BF was higher. Achieving the appropriateness of antibiotics through escalation or continuation of the same antibiotics was more common than de-escalation. Appropriate early modification of antibiotics was associated with a decreased trend in-hospital mortality and LOS.
本研究探讨了使用多重聚合酶链反应（BioFire - FilmArray[法国生物梅里埃公司，马西 - 埃图瓦勒]）（BF）技术是否能减少或优化入住重症监护病房（ICU）的呼吸性脓毒症患者的抗生素使用。
这项回顾性观察研究纳入了入住ICU的成年肺部脓毒症患者，使用下呼吸道样本进行BF检测。主要结局指标是在送检样本后24小时内根据BF指导进行的任何适当的抗生素调整。比较两组患者的医院死亡率和住院时间（LOS）：一组是在送检样本进行BF检测后24小时内抗生素得到适当调整的患者，另一组是未进行适当调整的患者。
本研究共纳入117例社区获得性和医院获得性呼吸性脓毒症患者。平均急性生理与慢性健康状况评分系统（APACHE）IV评分为70.5±27.2，34例（29.1%）患者处于休克状态。31份样本（26.5%）的BF检测结果为阴性，而63份样本（53.8%）的培养结果为阴性。分别有62例（53%）、41例（35%）和14例（11.9%）的情况显示根据BF指导进行了抗生素降阶梯、升阶梯和未改变用药，但实际实现这些改变的分别为15例（24.2%）、40例（97.6%）和14例（100%）（p<0.0001）。与未进行抗生素调整的病例相比，在有指征且进行了抗生素调整的病例中，医院死亡率和LOS较低（无统计学意义）。
使用BF鉴定病原体的成功率更高。通过升级或继续使用相同抗生素来实现抗生素的适当使用比降阶梯更为常见。早期适当调整抗生素与医院死亡率和LOS呈下降趋势相关。
