Impact of a strategy using multiplex PCR on targeted antibiotic therapy for patients with suspected ventilator-associated pneumonia or hospital-acquired pneumonia requiring mechanical ventilation: a randomized, single-blind trial.

Abstract

Ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia requiring mechanical ventilation (vHAP) are frequent in intensive care units and require prompt diagnosis. The FilmArray Pneumonia Panel (FAPP) enables fast pathogen identification, but its clinical impact remains uncertain. To assess whether adding FAPP to conventional microbiology increases the rate of targeted antimicrobial therapy (AMT) in patients with suspected VAP or vHAP. Open-label, multicenter randomized-controlled trial in immunocompetent adults with suspected VAP or vHAP. Patients were randomized to management with FAPP plus conventional microbiology or conventional microbiology alone. The primary outcome was the proportion of patients receiving targeted AMT 24 h after inclusion. From June 2020 to September 2023, 156 patients were randomized; 146 were analyzed (74 intervention, 72 control), as 10 did not provide consent for continued participation. Median age was 58 years (interquartile range, 43-70), 67.8% were male, 84.9% had VAP, and mean SOFA score was 8.0 ± 3.5. Targeted AMT at 24 h was achieved in 35.1% of the experimental group versus 23.6% of the control group [absolute difference (AD), 11.5%; 95% confidence interval (CI), -0.03 to 26.2, p = 0.13]. Secondary outcomes did not differ significantly. Among patients with culture-documented pneumonia (45.9%), targeted AMT at 24 h was achieved in 55.3% versus 31.0%, respectively (AD, 24.2%; 95% CI, 1.1 to 47.4, p = 0.048). Adding FAPP was not associated with a significant increase in targeted AMT at 24 h in patients with suspected VAP or vHAP, except in those with confirmed pneumonia.