Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study

Ventilator-associated bacterial pneumonia (VABP) is a common infection in critically ill patients in intensive care units (ICU), with attributable mortality of up to 13%, and its etiological diagnosis remains challenging. We conducted a multicenter, prospective, observational study within the MULTI-SITA platform to assess the impact on relevant clinical and antimicrobial stewardship outcomes of the use of a molecular syndromic panel (BIOFIRE® FILMARRAY® Pneumonia plus), in addition to a standard approach based on culture. The primary outcome measure was 30-day mortality from VABP onset. Overall, 237 patients with VABP were included in the study. In multivariable analysis, SOFA score (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.04–1.22, p = 0.003), previous isolation of carbapenem-resistant Pseudomonas aeruginosa (HR 3.02, 95% CI 1.25–7.32, p = 0.015), and solid neoplasm (HR 2.15, 95% CI 1.12–4.14, p = 0.022) were associated with increased mortality, while no association was registered for the molecular syndromic panel performed (HR 1.07, 95% CI 0.59–1.93, p = 0.825). In secondary analyses, use of the molecular syndromic panel resulted in more events of either de-escalation or initiation of appropriate antibiotic therapy at day 1 from VABP onset in comparison with a standard approach based on culture only (41.3% vs. 27.8%, p = 0.041). The use of a molecular syndromic panel in patients with VABP was able to impact antibiotic decisions, without an unfavorable effect on mortality. Further study is necessary to assess the long-term effects in terms of antimicrobial stewardship of molecular syndromic panels-based antibiotic treatment decisions.

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Journal
Critical Care
Published
2025-09-25
DOI
https://doi.org/10.1186/s13054-025-05632-z
Primary Topic
Nosocomial Infections in ICU
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article
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article

Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study

Giulia Spurio, Federica Portunato, Chiara Fanelli, Antonio Di Biagio et al.
Critical Care
Nosocomial Infections in ICU
article

Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study

Giulia Spurio, Federica Portunato, Chiara Fanelli, Antonio Di Biagio, Vincenzo Scaglione, Maria Mazzitelli, Nicoletta Boffa, Matteo Rinaldi, Nicola Rosso, Laura Magnasco, Chiara Oltolini, Anna Gidari, Gian María Rossolini, Alessandro Limongelli, Marco Ripa, Andrea Parisini, Małgorzata Mikulska, Nicholas Geremia, Alessio Signori, Chiara Maci, Andrea Lombardi, Salvatore Gallone, Daniele Riccucci, Marco Piscaglia, Greta Cattardico, Carlo Pallotto, Antonino Giarratano, Marco Muccio, Paola Del Giacomo, Alice Cappello, Matteo Bassetti, Sara Grignolo, Mara Tomasello, Edoardo Campanella, Carlo Alberto Peri, Nicoletta Bobbio, Lisa Malincarne, Pierluigi Viale, Francesco Saverio Serino, Gennaro De Pascale, Antonella Castagna, Ivana Maida, Giuseppe Vittorio De Socio, Vincenzo Di Pilato, Mauro Giacomini, Elena Potenza, Brunella Posteraro, Sara Mora, Sandro Panese, Emanuele Pontali, Stefania Tigano, Federico D’Amico, Anna Marchese, Giovanna Travi, Maddalena Giannella, Lorenzo Ball, Annalisa Garlaschelli, Sabrina Guastavino, Gabriele Di Meco, Alessandra Bandera, Giacomo Grasselli, Paola Morici, Daniele Roberto Giacobbe, Cristina Campi, Antonio Vena, Antonio Muscatello, Marta Colaneri, Nicolo’ Antonino Patroniti, Marco Merli, Filippo Del Puente, Federica Cosentino, Roberta Monardo, Andrea Marıno, Maria Chiara Meloni, Mariachiara Ippolito, A. Caroli, Davide Mangioni, Carlo Torti, Laura Curci, Chiara Gullotta, Chiara Robba, Maurizio Sanguinetti, E. Simoncini, Giulia Catalisano, Michele Piana, Federica Briano, Denise Battaglini, Claudia Bartalucci, Bruno Cacopardo, Giulia Viglietti, Elena Momesso, Matteo Passerini, Ylenia Murgia, Fabiola Cammarota, Annamaria Cattelan, Antonino Di Fede, Vincenzo Spagnuolo, M. Di Maio, Andrea Cortegiani, L. De Paola, S Sassi, Giacomo Gonnelli, Annaflavia Lamarina, Stefano Antola
article en

Abstract

Ventilator-associated bacterial pneumonia (VABP) is a common infection in critically ill patients in intensive care units (ICU), with attributable mortality of up to 13%, and its etiological diagnosis remains challenging. We conducted a multicenter, prospective, observational study within the MULTI-SITA platform to assess the impact on relevant clinical and antimicrobial stewardship outcomes of the use of a molecular syndromic panel (BIOFIRE® FILMARRAY® Pneumonia plus), in addition to a standard approach based on culture. The primary outcome measure was 30-day mortality from VABP onset. Overall, 237 patients with VABP were included in the study. In multivariable analysis, SOFA score (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.04–1.22, p = 0.003), previous isolation of carbapenem-resistant Pseudomonas aeruginosa (HR 3.02, 95% CI 1.25–7.32, p = 0.015), and solid neoplasm (HR 2.15, 95% CI 1.12–4.14, p = 0.022) were associated with increased mortality, while no association was registered for the molecular syndromic panel performed (HR 1.07, 95% CI 0.59–1.93, p = 0.825). In secondary analyses, use of the molecular syndromic panel resulted in more events of either de-escalation or initiation of appropriate antibiotic therapy at day 1 from VABP onset in comparison with a standard approach based on culture only (41.3% vs. 27.8%, p = 0.041). The use of a molecular syndromic panel in patients with VABP was able to impact antibiotic decisions, without an unfavorable effect on mortality. Further study is necessary to assess the long-term effects in terms of antimicrobial stewardship of molecular syndromic panels-based antibiotic treatment decisions.

Critical CareVol. 29(1)
Università Cattolica del Sacro Cuore (IT), AOL (United States) (US), University of Padua (IT), Vita-Salute San Raffaele University (IT), University of Sassari (IT), University of Milan (IT), University of Perugia (IT), Agostino Gemelli University Polyclinic (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Ente Ospedaliero Ospedali Galliera (IT), University of Catania (IT), Luigi Sacco Hospital (IT), Azienda Ospedaliera di Perugia (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), AULSS 2 Marca Trevigiana (IT), Ospedale di San Donà di Piave (IT), Ospedale San Paolo (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Ospedale Santa Maria (IT), Azienda USL di Bologna (IT), Ospedale dell' Angelo (IT), Ospedale Policlinico San Martino (IT), Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Florence (IT), University of Genoa (IT), University of Palermo (IT), University of Bologna (IT)
Openalex Percentile: Top 70%
Nosocomial Infections in ICU
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