综合征分子诊断对重症肺炎患者抗菌药物使用合理性及治疗及时性的影响：一项随机试验的系统评价和荟萃分析
Impact of syndromic molecular diagnostics on antimicrobial adequacy and time to therapy in critically ill patients with pneumonia: a systematic review and meta-analysis of randomized trials.
作者信息
de Albuquerque Pessoa Dos Santos Yuri, Tomazini Bruno Martins, Dos Santos Maurício Henrique Claro, de Queiroz Eduardo Lyra, Pastore Júnior Laerte, Costa Eduardo Leite Vieira, da Silva Ramos Fernando José
机构信息
Intensive Care Unit, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Bela Vista, São Paulo, 01308-050, SP, Brazil.
Research Institute, Hospital do Coração (HCor), Rua Desembargador Eliseu Guilherme, 147, Paraíso, São Paulo, 04004-030, SP, Brazil.
出版信息
Crit Care. 2025 Aug 22;29(1):379. doi: 10.1186/s13054-025-05623-0.
BACKGROUND
Pneumonia is a leading cause of ICU admission and mortality, requiring prompt and adequate antimicrobial therapy to improve outcomes. Conventional cultures are slow and often insensitive, delaying targeted treatment. Syndromic PCR panels offer rapid identification of pathogens and resistance genes directly from respiratory samples, potentially improving early antibiotic optimization. However, the true clinical benefit of these diagnostics in critically ill patients remains uncertain.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing PCR-based molecular diagnostics with standard culture techniques in predominantly adult ICU patients with severe community-acquired, hospital-acquired, or ventilator-associated pneumonia. Literature searches were performed in PubMed, Embase, and Cochrane CENTRAL from inception to July 16, 2025. The primary outcome was in-hospital mortality. Secondary outcomes included adequacy of initial antimicrobial therapy and time to effective antibiotic administration. Data were synthesized using random-effects models.
RESULTS
We included five randomized controlled trials comprising 2,466 patients. Syndromic PCR testing did not significantly reduce in-hospital mortality, the primary outcome (RR 1.04; 95% CI: 0.90–1.21; = 0.57; I² = 0%). However, PCR testing was associated with a higher rate of adequate initial antimicrobial therapy (RR 1.82; 95% CI: 1.10–3.00; = 0.02; I² = 97%) and a reduction in time to effective antibiotic administration (mean difference − 27.98 h; 95% CI: − 46.07 to − 9.89; = 0.002; I² = 94%).
CONCLUSIONS
Syndromic PCR diagnostics did not reduce in-hospital mortality in critically ill patients with pneumonia but were associated with improved adequacy of initial antimicrobial therapy and faster initiation of effective treatment. These findings support their role as a complementary tool in ICU-based antimicrobial stewardship.
TRIAL REGISTRATION
PROSPERO CRD420251006301.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s13054-025-05623-0.
背景
肺炎是重症监护病房（ICU）收治和死亡的主要原因，需要及时且充分的抗菌治疗以改善预后。传统培养方法耗时且往往不敏感，会延误针对性治疗。综合征聚合酶链反应（PCR）检测板可直接从呼吸道样本中快速鉴定病原体和耐药基因，可能改善早期抗生素的优化使用。然而，这些诊断方法在重症患者中的真正临床益处仍不确定。
方法
我们对随机对照试验（RCT）进行了系统评价和荟萃分析，比较基于PCR的分子诊断方法与标准培养技术在主要为成年ICU患者的重症社区获得性肺炎、医院获得性肺炎或呼吸机相关性肺炎中的应用。从数据库建立至2025年7月16日在PubMed、Embase和Cochrane CENTRAL中进行文献检索。主要结局是住院死亡率。次要结局包括初始抗菌治疗的充分性和有效抗生素给药时间。使用随机效应模型对数据进行综合分析。
结果
我们纳入了五项随机对照试验，共2466例患者。综合征PCR检测并未显著降低主要结局住院死亡率（风险比1.04；95%置信区间：0.90–1.21；P = 0.57；I² = 0%）。然而，PCR检测与更高的初始抗菌治疗充分率相关（风险比1.82；95%置信区间：1.10–3.00；P = 0.02；I² = 97%），且有效抗生素给药时间缩短（平均差−27.98小时；95%置信区间：−46.07至−9.89；P = 0.002；I² = 94%）。
结论
综合征PCR诊断方法未降低重症肺炎患者的住院死亡率，但与初始抗菌治疗充分性的改善以及有效治疗的更快启动相关。这些发现支持了其作为基于ICU的抗菌管理补充工具的作用。
试验注册
PROSPERO CRD420251006301。
补充信息
在线版本包含可在10.1186/s13054-025-05623-0获取的补充材料。
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