Multiplex PCR in Donor and Recipient Bronchoalveolar Lavage to Guide Early Antibiotic Prophylaxis Adaptation in Lung Transplantation: A Single-Center Cohort Study

<b>Background/Objectives</b>: International guidelines recommend the use of antibiotic prophylaxis for lung transplantation (LT). Although multiplex PCR (mPCR) has been shown to hasten antibiotic adaptation during pneumonia, its use to guide antibiotic prophylaxis in patients undergoing LT has not been described. We aimed to determine whether mPCR in bronchoalveolar lavage (BAL) in donor and recipient allows the early adaptation of antibiotic prophylaxis during LT. <b>Methods</b>: a retrospective, single-center study to evaluate the proportion of patients for whom mPCR (FilmArray Pneumonia Plus Panel^®, Biomérieux (FAPP)) in the donor and recipient BAL resulted in an early modification of antibiotic prophylaxis. We also compared the time to results using mPCR and standard microbiology and the time spent with inadequate antibiotic prophylaxis. <b>Results</b>: Forty-one patients were included. Donor and recipient mPCR resulted in the early adaptation of antibiotic prophylaxis in 10 (24%) patients. Standard microbiology confirmed the results of mPCR in 90% of them. FAPP resulted in an antibiotic escalation based on donor (9/10) or recipient (1/10) BAL identification, mainly Group 3 Enterobacterales and non-fermenting Gram-negative bacilli. The time to results was 1.7 (1.5-2.4) h for mPCR vs. 74.3 (41.5-92.7) h for standard microbiology (<i>p</i> < 0.001) on donor BAL and 1.7 (1.5-2.4) h vs. 92.8 (48.4-112.9) h (<i>p</i> < 0.001) on recipient BAL. Patients with mPCR-based adaptation had a 71.9 (30.7-92.1) h reduction in the duration of inadequate antibiotic prophylaxis. <b>Conclusions</b>: mPCR in donor and recipient BAL during LT might lead to faster adaptation and a reduction in the time spent with inadequate antibiotic prophylaxis.