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Molecular testing and multiplex panel approaches for diagnosis

The effects of introduction of a syndromic PCR sputum testing in intensive care unit pneumonia patients in a tertiary trauma centre

May 18 • O0394

D. Kluczna1, P. Burns1, D. Wearmouth1, P. Lillie1

1) Hull University Teaching Hospitals NHS Trust, Kingston-upon-Hull, United Kingdom

Background: Pneumonia is one of the most common diagnoses in ICU and carries up to 50% mortality rates. It is also associated with high healthcare costs. Microbiological diagnosis allows targeting of antimicrobial therapy and has been shown to improve patient outcomes. Standard culture of sputum samples has limitations due to time required to obtain results. BioFire offers a syndromic panel of multiplex PCR to identify pathogens rapidly. It is currently unknown if this molecular diagnostic test improves patient outcomes or what effect it has on pneumonia management.

Materials/methods: The study analyzed notes of pneumonia patients admitted to ICUs in Hull hospitals between 1st August and 31st December 2018 and 2019, before and after the introduction of BIOFIRE® Pneumonia plus Panel (PNplus Panel) testing. The primary outcome of this observational study was the length of ICU stay and the secondary outcomes included the following: 1) ventilation duration, 2) mortality, 3) number of antibiotics before and after microbiological testing, 4) time from sample collection to a) management change, b) extubation and c) discharge from ICU.

Results: The review of all sputum samples received in the laboratory during the set time period in 2018 identified 120 patients with radiologically confirmed pneumonia. So far, 78 patients have been identified in the 2019 period. Although there was no reduction of median ICU stay duration, a reduction of prolonged ICU stay frequency was observed in 2019 in comparison to 2018 (61.5% and 65% respectively). We observed a reduction in number of antibiotics prescribed per patient following microbiology results in both groups. This reduction occurred sooner in 2019 group, within 1.2 days, compared to 3.3 days in 2018 group from the time of sample collection (p<0.001). There was a reduction in time from sample collection to extubation of 3.4 days and to ICU discharge of 5.4 days in 2019 compared to 2018 group. We also observed a reduction in mortality rates within 30 days of ICU discharge (28.3% vs 24.4% in 2018 and 2019 groups respectively, p<0.05).

Conclusions: Rapid molecular diagnostics allows adjustment of antimicrobial therapy and has potential for improving patient outcomes.

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Pneumonia Panel

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