Title :

Respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in severe SARS-CoV-2 pneumonia: a multicenter randomised controlled trial

Author(s) :

Fartoukh, Muriel [Auteur correspondant]
CHU Tenon [AP-HP]
Nseir, Saad [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 [UGSF]
Mégarbane, Bruno [Auteur]
Optimisation thérapeutique en Neuropsychopharmacologie [OPTeN (UMR_S 1144 / U1144)]
Cohen, Yves [Auteur]
Lafarge, Antoine [Auteur]
Contou, Damien [Auteur]
Thille, Arnaud [Auteur]
Galerneau, Louis-Marie [Auteur]
Hypoxie et PhysioPathologie [HP2]
Reizine, Florian [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Cour, Martin [Auteur]
Hospices Civils de Lyon [HCL]
Klouche, Kada [Auteur]
Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] [PhyMedExp]
Centre Hospitalier Régional Universitaire [Montpellier] [CHRU Montpellier]
Navellou, Jean-Christophe [Auteur]
Bitker, Laurent [Auteur]
Rousseau, Alexandra [Auteur]
Tuffet, Sophie [Auteur]
Simon, Tabassome [Auteur]
Voiriot, Guillaume [Auteur]
Elabbadi, Alexandre [Auteur]
Turpin, Matthieu [Auteur]
Verdet, Charlotte [Auteur]
Préau, Sébastien [Auteur]
Institut Pasteur de Lille
Wallet, Frédéric [Auteur]
Institut Pasteur de Lille
Loiez, Caroline [Auteur]
Institut Pasteur de Lille
Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 [CIIL]
Voicu, Sebastian [Auteur]
Optimisation thérapeutique en Neuropsychopharmacologie [OPTeN (UMR_S 1144 / U1144)]
Jacquier, Hervé [Auteur]
Infection, Anti-microbiens, Modélisation, Evolution [IAME (UMR_S_1137 / U1137)]
Tandjaoui-Lambiotte, Yacine [Auteur]
Jaureguy, Françoise [Auteur]
Infection, Anti-microbiens, Modélisation, Evolution [IAME (UMR_S_1137 / U1137)]
Alloui, Chakib [Auteur]
Azoulay, Elie [Auteur]
Bercot, Béatrice [Auteur]
Infection, Anti-microbiens, Modélisation, Evolution [IAME (UMR_S_1137 / U1137)]
Plantefeve, Gaëtan [Auteur]
Claudinon-Courpon, Aurore [Auteur]
Henry, Amandine [Auteur]
Pichon, Maxime [Auteur]
Schwebel, Carole [Auteur]
Tadié, Jean-Marc [Auteur]
Microenvironment and B-cells: Immunopathology,Cell Differentiation, and Cancer [MOBIDIC]
Centre d'Investigation Clinique [Rennes] [CIC]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Auger, Gabriel [Auteur]
Argaud, Laurent [Auteur]
Chabchoub, Malek [Auteur]
Kolenda, Camille [Auteur]
Vandenesch, François [Auteur]
Centre International de Recherche en Infectiologie [CIRI]
Godreuil, Sylvain [Auteur]
Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle [MIVEGEC]
Piton, Gael [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Jeannot, Kay [Auteur]
Laboratoire Chrono-environnement (UMR 6249) [LCE]
Danjou, William [Auteur]
Hospices Civils de Lyon [HCL]

Journal title :

Clinical Microbiology and Infection

Pages :

734-743

Publisher :

Elsevier for the European Society of Clinical Microbiology and Infectious Diseases

Publication date :

2023-01

ISSN :

1198-743X

English keyword(s) :

Antibiotics use
Covid-19
Intensive care unit
Multiplex PCR
Randomised controlled trial

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Objectives: We aimed at assessing the efficacy and safety on antibiotics exposure of a strategy combining a respiratory multiplex PCR (mPCR) with enlarged panel and daily procalcitonin (PCT) measurements, as compared with ...
Show more >Objectives: We aimed at assessing the efficacy and safety on antibiotics 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 critically ill adult patients with laboratory-confirmed SARS-CoV-2 pneumonia.Methods: This multicentre, parallel-group, open-label, randomised controlled trial enrolled patients admitted to 13 intensive care units (ICU) in France. Patients were assigned (1:1) to the control strategy, where antibiotic streamlining remained at the discretion of the physicians, or interventional strategy, consisting of using mPCR and daily PCT measurements within the first seven days of randomisation 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 20st and November 23st 2020, 194 patients were randomised, of whom 191 were retained in the intention-to-treat analysis. Respiratory bacterial coinfection 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.Conclusion: 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.Show less >

Language :

Anglais

Popular science :

Non

Collections :

• Centre d'Infection et d'Immunité de Lille (CIIL) - U1019 - UMR 9017

Source :

Harvested from HAL