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

• DOI: 10.1016/j.cmi.2023.01.009
• Publication Date: 2023-01-18T18:46:12Z
• Authors: Muriel Fartoukh; Saad Nseir; Bruno Mégarbane; Yves Cohen; Antoine Lafarge; Damien Contou; Arnaud W. Thille; Louis-Marie Galer...; Florian Reizine; Martin Cour; Kada Klouche; Jean-Christophe N...; Laurent Bitker; Alexandra Rousseau; Sophie Tuffet; Tabassome Simon; Guillaume Voiriot
• Keywords: Randomised controlled trial; Adult; SARS-CoV-2; [SDV]Life Sciences [q-bio]; 610; COVID-19; Bacterial Infections; Multiplex PCR; Anti-Bacterial Agents; 3. Good health; 618; [SDV] Life Sciences [q-bio]; 03 medical and health sciences; Treatment Outcome; COVID-19 Testing; 0302 clinical medicine; 616; Antibiotics use; Humans; Intensive care unit; Original Article; Covid-19; Procalcitonin; Multiplex Polymerase Chain Reaction; Respiratory Tract Infections

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.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.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.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.