TOPLINE:
Rapid polymerase chain reaction (PCR) testing in the intensive care unit (ICU) resulted in improved antibiotic stewardship relative to standard care but could not demonstrate non-inferiority in the clinical cure of pneumonia.
METHODOLOGY:
- Researchers conducted a randomised controlled trial to assess the impact of PCR-based pathogen detection on antibiotic stewardship and clinical outcomes in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) across England.
- A total of 453 adults (median age, 61 years) and 92 children (median age, 7.5 months) with HAP or VAP who were about to receive empiric antibiotic therapy or have their antibiotic therapy changed were assigned to undergo either rapid syndromic PCR testing in the ICU or standard culture-based microbiological testing.
- The two co-primary outcomes evaluated were as follows:
- Superiority in antibiotic stewardship 24 hours after randomisation, defined as the proportion of patients receiving appropriate (antibacterially active against the identified organism[s]) and proportionate (not excessively broad-spectrum for the identified pathogen[s]) antibiotic therapy
- Non-inferiority in clinical cure of pneumonia at 14 days, with clinical cure defined as the absence of death, septic shock, pneumonia relapse, or other signs of uncured pneumonia
- Secondary outcomes included 28-day mortality, incidence of septic shock, changes in organ dysfunction scores, and antibiotic hypersensitivity.
TAKEAWAY:
- Superiority in antibiotic stewardship was achieved in patients in the intervention group vs those in the control group (76.5% vs 55.9%; odds ratio, 2.57; 95% CI, 1.77-3.73).
- However, non-inferiority in clinical cure was not achieved, and the clinical cure rate at 14 days was lower in the intervention group (56.7%) than in the control group (64.5%).
- Progression of organ dysfunction, 28-day mortality, and antibiotic-associated adverse events, including septic shock, severe antibiotic hypersensitivity, and secondary pneumonia, did not vary significantly between the groups.
IN PRACTICE:
"We recommend that use of syndromic PCR to narrow antibiotic therapy should be cautious. We do not advise modification of current prescribing strategies until further data are available," the authors wrote.
SOURCE:
The study was led by Virve I. Enne, Centre for Clinical Microbiology, Royal Free Hospital, Centre for Clinical Microbiology, Royal Free Hospital, University College London, London, United Kingdom. It was published online on February 17, 2025, in Intensive Care Medicine.
LIMITATIONS:
A key limitation of the study was its focus on England, where antibiotic resistance is low, limiting the relevance of PCR-panel tests for detecting resistance genes. The treatment algorithm offered recommendations rather than strict regimens, leading to low compliance, which may have affected outcomes.
DISCLOSURES:
The study was funded by the National Institute for Health Research (NIHR) and the NIHR University College London and Imperial College London Biomedical Research Centres. Several authors disclosed financial relationships, including consultancy, speaker fees, employment, or equity holdings, with pharmaceutical organisations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
