Point-of-care multiplex molecular diagnosis coupled with procalcitonin-guided algorithm for antibiotic stewardship in lower respiratory tract infection: a randomized controlled trial - Sorbonne Université Access content directly
Journal Articles Clinical Microbiology and Infection Year : 2023

Point-of-care multiplex molecular diagnosis coupled with procalcitonin-guided algorithm for antibiotic stewardship in lower respiratory tract infection: a randomized controlled trial

Abstract

Objective: We aimed to show that coupling molecular syndromic respiratory panel (RP) testing with procalcitonin (PCT) measurement in the emergency department improves antibiotic (ATB) stewardship in lower respiratory tract infection (LRTI). Methods: Open label, prospective, randomized interventional trial, conducted from 2019 to 2022 in an adult emergency department. Patients with a suspicion of LRTI were randomized into an intervention arm (PCT measurement and point of care BIOFIRE® RP2.1 plus testing, accompanied by a recommended ATB algorithm) or a standard of care (SOC) arm (PCT allowed as current practice). The primary endpoint was the duration of antibiotic exposure. Results: 451 patients were randomized, median age 65 years (Q1-Q3: 49 – 77), hospitalization rate was 59.9% (270/451), median length of stay 5 days (Q1-Q3: 3 – 12), and 28-day mortality rate 5.3% (23/451). The median duration of ATB exposure was 6 days (Q1-Q3: 0 – 9) and 5 days (Q1-Q3: 0 – 9) in the SOC and interventional arm respectively (p=0.71). ATB was started in 29.6 % (67/226) and 33.8% (76/225) respectively (p=0.54). The BIOFIRE® RP2.1 plus identified at least one viral species in 112/225 patients (49.8%) of intervention arm. 212/226 (93.8%) SOC patients had PCT measurement. The adherence rate to algorithm in the intervention arm was 93.3 % (210/225). Conclusion: Displaying PCT and real-time RP results to emergency physicians failed to significantly reduce ATB exposure in LRTI suspicions. However, the median ATB duration and rate of initiation were already low in the SOC arm using PCT measurement routinely.
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Dates and versions

hal-04267996 , version 1 (02-11-2023)

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Laetitia Velly, Marta Cancella de Abreu, David Boutolleau, Ilaria Cherubini, Enfel Houas, et al.. Point-of-care multiplex molecular diagnosis coupled with procalcitonin-guided algorithm for antibiotic stewardship in lower respiratory tract infection: a randomized controlled trial. Clinical Microbiology and Infection, 2023, 29 (11), pp.1409-1416. ⟨10.1016/j.cmi.2023.07.031⟩. ⟨hal-04267996⟩
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