Scholarlink

Purpose <p>Multiplex polymerase chain reaction (mPCR) testing has the potential to rapidly and accurately identify causative microorganisms in patients with community-acquired pneumonia (CAP). Its use in a management strategy, along with biomarkers, may reduce antibiotic exposure and improve clinical outcomes.</p> Methods <p>The MULTI-CAP trial was a multicenter (<i>n</i> = 20), parallel-group, superiority, open-label, randomized trial. Subjects were non-immunocompromised adult patients (≥ 18&#xa0;years) admitted to the intensive care unit (ICU) for CAP and randomly assigned in a 1:1 ratio. In the intervention group, the microbiological diagnosis combined a broad-spectrum respiratory mPCR and conventional microbiological investigations. An algorithm for early discontinuation or de-escalation of antibiotics was applied, based on mPCR results and serum procalcitonin. In the control group, only conventional microbiological investigations were performed. In both groups, antibiotic discontinuation was considered on Day 3 and day after day until Day 7, based on procalcitonin values and kinetics. The primary endpoint was defined as the number of days alive without any antibiotic from the time of enrollment to Day 28.</p> Results <p>From October 4, 2018, to March 3, 2022, 406 patients were randomized, and 385 were evaluable in the intention-to-treat analysis. The median number of days alive without antibiotics on Day 28 was 19.0 (0.0; 24.0) days in the intervention group and 19.0 (7.0; 22.0) days in the control group (difference, 0.0 (95% CI, −&#xa0;4.0 to 4.0). However, the antibiotic cumulative duration on day 28 was 3&#xa0;days shorter (95% CI, −&#xa0;5.1 to −&#xa0;0.9) in the intervention group. Serious adverse events did not differ between groups.</p> Conclusion <p>In ICU patients with CAP, a management strategy combining a mPCR and serum procalcitonin failed to reduce antibiotic exposure or improve outcomes on Day 28, compared to usual care.</p> Trial registration number <p>NCT03452826 (March 2018), EudraCT 2017-A01615-48.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Combined use of a multiplex PCR and serum procalcitonin to reduce antibiotic exposure in critically ill patients with community-acquired pneumonia: the MULTI-CAP randomized controlled trial

  • 期刊论文

  • 发表日期：

    2025年7月15日

查看全文
  • Guillaume Voiriot,
  • Laurent Argaud,
  • Yves Cohen,
  • Sophie Tuffet,
  • Louis Chauvelot,
  • Bertrand Souweine,
  • Kada Klouche,
  • Jean Reignier,
  • Carole Schwebel,
  • Anahita Rouzé,
  • Armand Mekontso Dessap,
  • Julien Bohé,
  • Bruno Megarbane,
  • Julien Carvelli,
  • Jean-Christophe Navellou,
  • Sébastien Gibot,
  • Éric Maury,
  • Jean Dellamonica,
  • Pierre-François Dequin,
  • Julien Dessajan,
  • Laurence Armand-Lefèvre,
  • Francois Vandenesch,
  • Charlotte Verdet,
  • Isabelle Durand Zaleski,
  • Laurence Bérard,
  • Alexandra Rousseau,
  • Simon Tabassome,
  • Muriel Fartoukh,
  • Jean-François Timsit,
  • Bibi Fabiola Ngaleu Siaha,
  • Matthieu Turpin,
  • Aude Gibelin,
  • Nina de Montmollin,
  • Cyrielle Desnos,
  • Lila Bouadma,
  • Etienne de Montmollin,
  • Marc Doman,
  • Michael Thy,
  • Romain Sonneville,
  • Fariza Lamara,
  • Michael Eczenberg,
  • Guilhem Courte,
  • Gaël Piton,
  • Katy Jeannot,
  • Martin Cour,
  • Marion Provent,
  • Marc Gainnier,
  • Olivier Dauwalder,
  • Jean-Christophe Richard,
  • Hervé Jacquier,
  • Emmanuelle Cambau,
  • Jean Luc Baudel,
  • Jacques Tankovic,
  • Frédéric Wallet,
  • Saad Nseir,
  • Françoise Jauréguy,
  • Florent Wallet

摘要

Purpose

Multiplex polymerase chain reaction (mPCR) testing has the potential to rapidly and accurately identify causative microorganisms in patients with community-acquired pneumonia (CAP). Its use in a management strategy, along with biomarkers, may reduce antibiotic exposure and improve clinical outcomes.

Methods

The MULTI-CAP trial was a multicenter (n = 20), parallel-group, superiority, open-label, randomized trial. Subjects were non-immunocompromised adult patients (≥ 18 years) admitted to the intensive care unit (ICU) for CAP and randomly assigned in a 1:1 ratio. In the intervention group, the microbiological diagnosis combined a broad-spectrum respiratory mPCR and conventional microbiological investigations. An algorithm for early discontinuation or de-escalation of antibiotics was applied, based on mPCR results and serum procalcitonin. In the control group, only conventional microbiological investigations were performed. In both groups, antibiotic discontinuation was considered on Day 3 and day after day until Day 7, based on procalcitonin values and kinetics. The primary endpoint was defined as the number of days alive without any antibiotic from the time of enrollment to Day 28.

Results

From October 4, 2018, to March 3, 2022, 406 patients were randomized, and 385 were evaluable in the intention-to-treat analysis. The median number of days alive without antibiotics on Day 28 was 19.0 (0.0; 24.0) days in the intervention group and 19.0 (7.0; 22.0) days in the control group (difference, 0.0 (95% CI, − 4.0 to 4.0). However, the antibiotic cumulative duration on day 28 was 3 days shorter (95% CI, − 5.1 to − 0.9) in the intervention group. Serious adverse events did not differ between groups.

Conclusion

In ICU patients with CAP, a management strategy combining a mPCR and serum procalcitonin failed to reduce antibiotic exposure or improve outcomes on Day 28, compared to usual care.

Trial registration number

NCT03452826 (March 2018), EudraCT 2017-A01615-48.