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Respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in severe SARS-CoV-2 pneumonia: a multicentre randomized controlled trial.
Fartoukh, Muriel; Nseir, Saad; Mégarbane, Bruno; Cohen, Yves; Lafarge, Antoine; Contou, Damien; Thille, Arnaud W; Galerneau, Louis-Marie; Reizine, Florian; Cour, Martin; Klouche, Kada; Navellou, Jean-Christophe; Bitker, Laurent; Rousseau, Alexandra; Tuffet, Sophie; Simon, Tabassome; Voiriot, Guillaume.
Afiliación
  • Fartoukh M; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Service de Médecine intensive réanimation, Paris, France. Electronic address: muriel.fartoukh@aphp.fr.
  • Nseir S; CHU de Lille, Médecine Intensive Réanimation, Inserm U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France.
  • Mégarbane B; Department of Medical and Toxicological Critical Care, APHP, Hôpital Lariboisière, Paris Cité University, INSERM UMRS-1144, Paris, France.
  • Cohen Y; Réanimation Médico-Chirurgicale/USC, APHP, Avicenne/Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Bobigny Cedex, France.
  • Lafarge A; Service de Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Université de Paris, Paris, France.
  • Contou D; Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
  • Thille AW; CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
  • Galerneau LM; Service de Médecine Intensive Réanimation, CHU Grenoble-Alpes, Laboratoire HP2 - Inserm U1042 Hypoxie et Physiopathologies cardiovasculaires et respiratoires, Grenoble, France.
  • Reizine F; Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France.
  • Cour M; Service de Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
  • Klouche K; Department of Intensive Care Medicine, Lapeyronie University Hospital, University of Montpellier, PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), School of Medicine, Montpellier, France.
  • Navellou JC; Service de réanimation médicale, CHU Jean Minjoz, Université de Bourgogne-Franche Comté, Equipe d'Accueil EA 3920, Besançon, France.
  • Bitker L; Service de Médecine Intensive Réanimation. Hôpital de la Croix-Rousse. Hospices Civils de Lyon, Lyon, France.
  • Rousseau A; Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), APHP, Hôpital St Antoine, Paris, France.
  • Tuffet S; Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), APHP, Hôpital St Antoine, Paris, France.
  • Simon T; Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), APHP, Hôpital St Antoine, Paris, France; Sorbonne University, Paris, France.
  • Voiriot G; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Service de Médecine intensive réanimation, Paris, France.
Clin Microbiol Infect ; 29(6): 734-743, 2023 Jun.
Article en En | MEDLINE | ID: mdl-36681325
OBJECTIVES: We aimed at assessing the efficacy and safety on antibiotic exposure of a strategy combining a respiratory multiplex PCR (mPCR) with enlarged panel and daily procalcitonin (PCT) measurements, as compared with a conventional strategy, in adult patients who were critically ill with laboratory-confirmed SARS-CoV-2 pneumonia. METHODS: This multicentre, parallel-group, open-label, randomized controlled trial enrolled patients admitted to 13 intensive care units (ICUs) in France. Patients were assigned (1:1) to the control strategy, in which antibiotic streamlining remained at the discretion of the physicians, or interventional strategy, consisting of using mPCR and daily PCT measurements within the first 7 days of randomization to streamline initial antibiotic therapy, with antibiotic continuation encouraged when PCT was >1 ng/mL and discouraged if < 1 ng/mL or decreased by 80% from baseline. All patients underwent conventional microbiological tests and cultures. The primary end point was antibiotic-free days at day 28. RESULTS: Between April 20th and November 23rd 2020, 194 patients were randomized, of whom 191 were retained in the intention-to-treat analysis. Respiratory bacterial co-infection was detected in 48.4% (45/93) and 21.4% (21/98) in the interventional and control group, respectively. The number of antibiotic-free days was 12.0 (0.0; 25.0) and 14.0 (0.0; 24.0) days, respectively (difference, -2.0, (95% CI, -10.6 to 6.6), p=0.89). Superinfection rates were high (51.6% and 48.5%, respectively). Mortality rates and ICU lengths of stay did not differ between groups. DISCUSSION: In severe SARS-CoV-2 pneumonia, the mPCR/PCT algorithm strategy did not affect 28-day antibiotics exposure nor the major clinical outcomes, as compared with routine practice.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones del Sistema Respiratorio / Infecciones Bacterianas / COVID-19 Tipo de estudio: Clinical_trials / Diagnostic_studies Límite: Adult / Humans Idioma: En Revista: Clin Microbiol Infect Asunto de la revista: DOENCAS TRANSMISSIVEIS / MICROBIOLOGIA Año: 2023 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones del Sistema Respiratorio / Infecciones Bacterianas / COVID-19 Tipo de estudio: Clinical_trials / Diagnostic_studies Límite: Adult / Humans Idioma: En Revista: Clin Microbiol Infect Asunto de la revista: DOENCAS TRANSMISSIVEIS / MICROBIOLOGIA Año: 2023 Tipo del documento: Article Pais de publicación: Reino Unido