PCR-based syndromic tests for antibiotic stewardship in non-ventilated patients with hospital-acquired pneumonia: a multicentre randomized controlled trial
Abstract
Abstract Objectives To evaluate whether syndromic multiplex PCR (mPCR) with expert guidance improves antibiotic stewardship in patients with hospital-acquired pneumonia (HAP). Methods We conducted a multicentre, open-label randomized controlled trial across seven French tertiary hospitals. Adults with non-ventilator-associated HAP in intensive care unit (ICU) or non-ICU wards were randomized (1:1) to conventional microbiology or mPCR testing. Empirical therapy was clinician-guided. In the intervention group, treatment was subsequently adapted according to mPCR results with expert advice. The primary endpoint was duration of broad-spectrum antibiotics (days of therapy/100 patient-days) in patients alive at end of follow-up. Secondary outcomes included appropriateness of antibiotic therapy, adverse outcomes, length of stay and costs. Results From February 2020 to August 2023, 116 patients were randomized and 109 included in follow-up (mPCR n = 55; control n = 54). Recruitment was disrupted by the COVID-19 pandemic, leading to early trial termination at half of the planned sample size. Median age was 66 years (IQR: 55–76), 66% patients were in ICU. Mean duration of broad-spectrum antibiotics was 37.6 days of therapy/100 patient-days (standard deviation, SD 44.1) in the mPCR group versus 48.7 (SD 54.5) in controls (P = 0.41). mPCR significantly increased appropriate antibiotic therapy at day 0 (47% versus 24%, P = 0.01). No differences were evidenced in adverse outcomes, length…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 55 participants or records.
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