Rapid PCR Testing in ICU Improves Antibiotic Stewardship

A collaborative study led by the University of Plymouth (Devon, UK) has shown that rapid polymerase chain reaction (PCR) testing in the intensive care unit (ICU) improved antibiotic stewardship compared to standard care, although it did not demonstrate non-inferiority in the clinical cure of pneumonia.

The INHALE WP3 trial, a multicenter, open-label, pragmatic randomized controlled trial, evaluated the impact of rapid, ICU-based syndromic PCR testing versus standard culture-based microbiological testing on antibiotic stewardship and clinical outcomes in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in the UK. The study involved 453 adults (median age, 61 years) and 92 children (median age, 7.5 months) with HAP or VAP, who were either about to begin empiric antibiotic treatment or have their current therapy modified. Participants were randomly assigned to receive either rapid syndromic PCR testing in the ICU or standard microbiological testing. The primary outcomes assessed were: superiority in antibiotic stewardship 24 hours after randomization, defined as the proportion of patients receiving appropriate and proportionate antibiotic therapy, and non-inferiority in clinical pneumonia cure at 14 days, which was defined as the absence of death, septic shock, pneumonia relapse, or other signs of ongoing infection.

Secondary outcomes included 28-day mortality, incidence of septic shock, changes in organ dysfunction scores, and antibiotic hypersensitivity. Published in Intensive Care Medicine, the study found that the intervention group achieved superior antibiotic stewardship compared to the control group (76.5% vs. 55.9%; odds ratio, 2.57; 95% CI, 1.77-3.73). However, non-inferiority in clinical cure was not demonstrated, with the intervention group showing a lower clinical cure rate at 14 days (56.7%) compared to the control group (64.5%). Furthermore, there were no significant differences between the groups regarding progression of organ dysfunction, 28-day mortality, or antibiotic-associated adverse events, including septic shock, severe antibiotic hypersensitivity, and secondary pneumonia.

"We recommend that use of syndromic PCR to narrow antibiotic therapy should be cautious. We do not advise modification of current prescribing strategies until further data are available," stated the researchers.

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