Background: Pneumonia remains a worldwide health problem with a high rate of morbidity and mortality. Microbiological diagnosis of pneumonia is fundamental to ensure appropriate antibiotic therapy, which is a big challenge for conventional microbiological methods. The development of molecular diagnostics for pneumonia has been a major advance in the microbiological diagnosis of respiratory pathogens in recent years. The aim of this study is to explore the potential impact BIOFIRE® Pneumonia plus Panel (PNplus Panel) with or without procalcitonin on antimicrobial stewardship.
Materials/methods: Total of 55 Respiratory samples collected from critically ill patients admitted to intensive care unit (ICU) at West Hertfordshire hospitals NHS trust, with radiologically confirmed new onset, pneumonia were taken for standard culture and sensitivity and molecular diagnosis using the PNplus Panel. Serum procalcitonin levels were measured. A microbiologist and intensivist reviewed antimicrobial prescriptions, inflammatory markers, procalcitonin results and daily SOFA data to determine: 1) Changes in antimicrobial prescription 2) Missed opportunities to change antimicrobial prescriptions. Further 60 patients from ICU, respiratory wards and outpatient clinics were also included in this study and data are under review.
Results: Data on 30 patients were included, 21 men, age range 26 to 86 (mean 60.9), APACHE score range 7 to 38 (mean 17). PNplus Panel resulted in the additional detection of 13 bacteria not cultured using standard technique. Antibiotics were stopped or de-escalated in eight and missed in seven patients. Earlier detection of resistance in two occasions by PNplus Panel. In 14 instances prescriptions were not changed but PNplus Panel enabled earlier diagnosis and reassurance. Viruses were detected in 7 patients. PNplus Panel missed one Mycoplasma and one Legionella. The procalcitonin result had an impact on two instances, antibiotics were stopped, nine additional instances were identified where the antibiotics could have been stopped. There were eight instances when a procalcitonin would have been helpful in informing the clinical discussion. The additional real time impact on the additional 60 patients and the cost effectiveness data is still being reviewed.
Conclusions: The results of this exploratory project suggest that PNplus Panel and appropriate procalcitonin results provide valuable information, with potential for better antimicrobial stewardship, specifically shorter courses.