Syndromic Testing Using Multiplex Polymerase Chain Reaction vs Conventional Standard of Care Testing: A Prospective Study to Assess the Clinical Response and Cost Effectiveness

Background and aims: Early identification and prompt management of sepsis is critical to decrease mortality.For this, timely identification of the pathogen and targeted therapy is essential.Multiplex polymerase chain reaction (PCR) provides results within one hour from positively flagged blood culture and lower respiratory tract secretions.This may reduce unnecessary broad-spectrum antibiotic use, improve patient outcomes, and decrease healthcare costs.Our study aimed to ascertain these benefits. Patients and methods:The study included adult intensive care unit (ICU) patients with suspected bloodstream or lower respiratory tract infections.Patients with other sources of infection were excluded.Of 138 patients assessed, 88 were randomized into two groups: Cases (underwent multiplex PCR testing at ICU admission) and controls (underwent standard culture and sensitivity testing).Antibiotic regimens were adjusted based on test results.Key outcomes analyzed during the first ICU week included Sequential Organ Failure Assessment (SOFA) scores, mortality, ICU length of stay, empirical antibiotic use, antibiotic adjustments, and associated costs.Results: There was a significant difference between the two groups in terms of delta SOFA (p = 0.025, a decrease in SOFA scores among cases), multiple bacterial growth detection (p 0.001, higher in cases), and change in antibiotics based on investigations (p 0.001, higher in cases).Mortality, ICU days and costs did not differ significantly between the groups.Conclusion: Multiplex PCR provides early, highly sensitive detection of pathogens, facilitating timely antibiotic adjustments and potentially improving clinical outcomes without any increase in costs.