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

作者：Daniele Roberto Giacobbe, Greta Cattardico, Claudia Bartalucci, Vincenzo Di Pilato, Marco Muccio, Alessandro Limongelli, Alessio Signori, Alessandra Bandera, Bruno Cacopardo, Edoardo Campanella, A. Caroli, Annamaria Cattelan, Marta Colaneri, Andrea Cortegiani, Laura Curci, Gennaro De Pascale, Giuseppe Vittorio De Socio, Filippo Del Puente, Antonino Di Fede, Chiara Fanelli, Nicholas Geremia, Maddalena Giannella, Giacomo Grasselli, Chiara Maci, Ivana Maida, Davide Mangioni, Andrea Marıno, Maria Mazzitelli, Maria Chiara Meloni, Marco Merli, Elena Momesso, Chiara Oltolini, Carlo Pallotto, Sandro Panese, Matteo Passerini, Emanuele Pontali, Daniele Riccucci, Matteo Rinaldi, Marco Ripa, Vincenzo Scaglione, Francesco Saverio Serino, Vincenzo Spagnuolo, Giulia Spurio, Stefania Tigano, Carlo Torti, Giovanna Travi, Laura Magnasco, Federica Portunato, Federica Briano, Małgorzata Mikulska, Lorenzo Ball, Chiara Robba, Nicolò Patroniti, Denise Battaglini, Mauro Giacomini, Gian María Rossolini, Maurizio Sanguinetti, Paola Morici, Anna Marchese, Antonio Vena, Matteo Bassetti, RAPID-SITA PHENOTYPES investigators, Ylenia Murgia, Gabriele Di Meco, Alice Cappello, Sabrina Guastavino, Cristina Campi, Michele Piana, Sara Mora, Nicola Rosso, Antonio Di Biagio, Giulia Viglietti, Annaflavia Lamarina, L. De Paola, Stefano Antola, Selene Gallone, Federica Cosentino, Chiara Gullotta, Marco Piscaglia, Federico D’Amico, Serena Sassi, E. Simoncini, Giacomo Gonnelli, Anna Gidari, Lisa Malincarne, Nicoletta Bobbio, Andrea Parisini, Annalisa Garlaschelli, Sara Grignolo, Fabiola Cammarota, Paola Del Giacomo, Brunella Posteraro, Andrea Lombardi, Antonio Muscatello, Carlo Alberto Peri, Mara Tomasello, Nicoletta Boffa, Elena Potenza, Antonella Castagna, Roberta Monardo, Giulia Catalisano, M. Di Maio, Antonino Giarratano, Mariachiara Ippolito, Pierluigi Viale · 发表于：Critical Care · 年份：2025 · DOI：10.1186/s13054-025-05632-z · 被引用次数：2 · 研究领域：Nosocomial Infections in ICU、Antibiotic Use and Resistance、Antibiotics Pharmacokinetics and Efficacy

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: The use of a molecular syndromic panel in patients with VABP was able to impa...