Multicentre evaluation of two multiplex PCR platforms for the rapid microbiological investigation of nosocomial pneumonia in UK ICUs: the INHALE WP1 study

Enne, Virve I., Aydin, Alp, Baldan, Rossella, Owen, Dewi R., Richardson, Hollian, Ricciardi, Federico, Russell, Charlotte, Nomamiukor-Ikeji, Brenda O., Swart, Ann Marie ORCID: https://orcid.org/0000-0002-9359-6995, High, Juliet, Colles, Antony, Barber, Julie A., Gant, Vanya, Livermore, David M. and O'Grady, Justin and INHALE WP1 Study Group (2022) Multicentre evaluation of two multiplex PCR platforms for the rapid microbiological investigation of nosocomial pneumonia in UK ICUs: the INHALE WP1 study. Thorax, 77 (12). pp. 1220-1228. ISSN 0040-6376

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Abstract

Background: Culture-based microbiological investigation of hospital-acquired or ventilator-associated pneumonia (HAP or VAP) is insensitive, with aetiological agents often unidentified. This can lead to excess antimicrobial treatment of patients with susceptible pathogens, while those with resistant bacteria are treated inadequately for prolonged periods. Using PCR to seek pathogens and their resistance genes directly from clinical samples may improve therapy and stewardship. Methods: Surplus routine lower respiratory tract samples were collected from intensive care unit patients about to receive new or changed antibiotics for hospital-onset lower respiratory tract infections at 15 UK hospitals. Testing was performed using the BioFire FilmArray Pneumonia Panel (bioMérieux) and Unyvero Pneumonia Panel (Curetis). Concordance analysis compared machine and routine microbiology results, while Bayesian latent class (BLC) analysis estimated the sensitivity and specificity of each test, incorporating information from both PCR panels and routine microbiology. Findings: In 652 eligible samples; PCR identified pathogens in considerably more samples compared with routine microbiology: 60.4% and 74.2% for Unyvero and FilmArray respectively vs 44.2% by routine microbiology. PCR tests also detected more pathogens per sample than routine microbiology. For common HAP/VAP pathogens, FilmArray had sensitivity of 91.7%–100.0% and specificity of 87.5%–99.5%; Unyvero had sensitivity of 50.0%–100.0%%, and specificity of 89.4%–99.0%. BLC analysis indicated that, compared with PCR, routine microbiology had low sensitivity, ranging from 27.0% to 69.4%. Interpretation: Conventional and BLC analysis demonstrated that both platforms performed similarly and were considerably more sensitive than routine microbiology, detecting potential pathogens in patient samples reported as culture negative. The increased sensitivity of detection realised by PCR offers potential for improved antimicrobial prescribing.

Item Type: Article
Additional Information: Funding Information: This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number: RP-PG-0514–20018). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care. The funder had no role in the study design, nor in the collection, analysis, and interpretation of data or in the writing of the report. The funder appointed an independent research Programme Steering Committee (PSC) to provide quality assurance and oversight. The corresponding author had full access to all study data and had final responsibility for the decision to submit for publication.
Uncontrolled Keywords: bacterial infection,critical care,pneumonia,respiratory infection,pulmonary and respiratory medicine ,/dk/atira/pure/subjectarea/asjc/2700/2740
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 08 Dec 2021 15:30
Last Modified: 15 Dec 2022 03:18
URI: https://ueaeprints.uea.ac.uk/id/eprint/82615
DOI: 10.1136/thoraxjnl-2021-216990

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