Antibiotic Escalation Following Rapid Multiplex PCR Pneumonia Panel Testing in Intensive Care Patients with Severe Pneumonia: A Retrospective Cohort Study
Abstract
Background/objectives: Severe community-acquired pneumonia (CAP) can be fatal and requires the rapid and appropriate administration of antibiotics. Rapid multiplex PCR pneumonia panels are widely used tools for antimicrobial de-escalation and stewardship; however, their role in driving antibiotic escalation in severe pneumonia requiring intensive care is less well characterized.
Methods: We retrospectively analyzed 288 adults with severe CAP who were admitted to the intensive care unit (ICU) of a tertiary hospital and underwent lower-respiratory BioFire FilmArray Pneumonia Panel (BFPP) testing between April 2023 and September 2024. The primary outcome was antibiotic escalation, defined as addition of an agent or a change to broader-spectrum therapy after the BFPP result, and its associated factors. Secondary outcomes were in-hospital mortality, hospital and ICU length of stay (LOS), and ventilator duration according to the antibiotic escalation.
Results: Patients were elderly (median 72 years old; 60.8% male) and critically ill (median SOFA 8; median APACHE-II 19; shock 49.0%; mechanical ventilation 56.9%). The panel was positive in 66.3% of cases, and results were obtained with a median turnaround time of 2 h versus 67 h for sputum culture. After the panel, antibiotics were escalated in 34.0% of cases, de-escalated in 2.8%, discontinued in 0.7%, and unchanged in 62.5%. Escalation was independently associated with resistance gene detection (adjusted odds ratio [aOR] 3.15,…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 288 participants or records.
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