Pneumonia Panel Helps Curb Inappropriate Antibiotic Usage

Pneumonia is swelling (inflammation) of the tissue in one or both lungs. It's usually caused by a bacterial infection or a virus. The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or they may come on more slowly over several days.

Pneumonia can affect people of any age, but it's more common, and can be more serious, in certain groups of people, such as the very young or the elderly. People in these groups are more likely to need hospital treatment if they develop pneumonia.

Pulmonologists at the University Hospital Basel (Basel, Switzerland) aimed to determine whether multiplex bacterial PCR of bronchoalveolar lavage fluid aids antibiotic stewardship in patients with pneumonia. They initiated a multicenter, randomized controlled trial that was conducted at two tertiary care centers in Switzerland. Between May 31, 2017, and Sept 25, 2019, 740 patients with pneumonia were screened for eligibility and 208 were included and randomly assigned to the PCR group (n=100) or conventional microbiology control group (n=108). The mean age of patients was 65.9 ± 14.0 years. and 135 (65%) were male.

The scientists used the Unyvero Hospitalized Pneumonia panel (Curetis, Holzgerlingen, Germany) in comparison with microbiological culture for detection of bacterial pathogens. The HPN panel covers 21 pathogens and 17 antimicrobial resistance (AMR) markers, providing results in a little less than five hours. The rapid multiplex PCR-based platform employs a closed cartridge-based approach used for specimen lysis, DNA extraction, PCR, and array hybridization and is CE marked and commercially available in CE-compliant countries.

The investigators reported that after daily follow-up until hospital discharge or for a maximum of 30 days, the duration of inappropriate antibiotic treatment was significantly shorter by 38.6 hours in the PCR group than in the control group (adjusted mean 47.1 hours versus 85.7 hours), which translates as a decrease in the duration of inappropriate antibiotic therapy of 45.0%. Adverse events due to antimicrobial therapy occurred in nine patients (five [5%] in the PCR group versus four [4%] in the control group) and due to bronchoscopy occurred in four patients (two [1%] versus two [1%]). There were eight (8%) deaths in the PCR group and 11 (10%) in the control group. All in-hospital deaths were attributed to a respiratory cause.

The Unyvero HPN demonstrated a sensitivity and specificity for Gram-negative rods of 55.6% percent and 86.6%, respectively, in line with past assessments, where factors such as sample origin, clinical setting, variability in microbial culture comparators, and the use of a first-generation or a newer panel showed sensitivity ranges of 57% to 97 % and specificities of 14% to 99%.

Oliver Schacht, PhD, CEO at OpGen (Rockville, MD, USA) whose product portfolio includes the Curetis Unyvero System, said, “Here we have a clinical trial that was done over several years, prospectively, randomized, tightly controlled, with interventional use of the Unyvero data and results in one patient cohort compared to the control group where doctors had standard-of-care microbiology results only.”

The authors concluded that multiplex bacterial PCR examination of bronchoalveolar lavage decreases the duration of inappropriate antibiotic therapy of patients admitted to hospital with pneumonia and at risk of Gram-negative rod infection. This approach warrants further consideration in future antibiotic stewardship strategies. The study was published on May 23, 2022 in the journal The Lancet.

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