Gram-negative pulmonary infections - advances in epidemiology and diagnosis.
Journal
Current opinion in pulmonary medicine
ISSN: 1531-6971
Titre abrégé: Curr Opin Pulm Med
Pays: United States
ID NLM: 9503765
Informations de publication
Date de publication:
01 05 2023
01 05 2023
Historique:
medline:
31
3
2023
pubmed:
15
3
2023
entrez:
14
3
2023
Statut:
ppublish
Résumé
Pulmonary infections due to Gram-negative organisms are increasing worldwide and traditional assumptions that these are limited to hospital and ventilator-acquired pneumonia are rapidly falling away. Accordingly, empiric antibiotic guidelines have to follow suit with ever broader spectrum choices in order to remain 'safe', as the Global prevalence of extensively resistant Gram-negative organisms inexorably increases. Rapid, multiplex PCR-based detection of a wide variety of potential pathogens offers the opportunity to replace empiric antibiotic choices with targeted, evidence-based therapy in clinically actionable timeframes. Here, we describe the data underpinning both the increasing global prevalence of Gram-negative pulmonary infections and their increasing antibiotic resistance. We also describe the performance, characteristics and early emerging clinical impact of already available rapid molecular diagnostic platforms and how they might best be deployed. It will likely be advantageous to replace the current trend for empiric prescription of increasingly broad-spectrum antibiotics with 'same day' evidence-based, targeted therapy using high performance, rapid molecular diagnostic solutions. Several challenges remain be overcome, however, to fully realize their clear potential for better, focussed deployment of antibiotics, improved patient outcomes and antibiotic stewardship.
Identifiants
pubmed: 36917219
doi: 10.1097/MCP.0000000000000957
pii: 00063198-202305000-00007
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
168-173Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study. Lancet Infect Dis 2018; 18:1191–1210.
Rhee C, Jones TM, Hamad Y, et al. Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Netw Open 2019; 2:e187571.
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200:e45–e67.
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63:e61–e111.
NICE 2019. Pneumonia in adults: diagnosis and management. Last updated: 16 September 2019 (reinstated 07 July 2022). www.nice.org.uk/guidance/cg191 . [Accessed 09 November 2022].
Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia 2020; 12:11.
Villafuerte D, Aliberti S, Soni NJ, et al. Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia. Respirology 2020; 25:543–551.
Kishimbo P, Sogone NM, Kalokola F, Mshana SE. Prevalence of gram negative bacteria causing community acquired pneumonia among adults in Mwanza City, Tanzania. Pneumonia 2020; 12:1–9.
Ibrahim A. Bacterial etiology of community acquired pneumonia and their antimicrobial susceptibility in patients admitted to Alshaab Teaching Hospital. Sudan Med Lab J 2018; 6:78–94.
Assefa M, Tigabu A, Belachew T, Tessema B. Bacterial profile, antimicrobial susceptibility patterns, and associated factors of community acquired pneumonia among adult patients in Gondar, Northwest Ethiopia: a cross-sectional study. PLoS One 2022; 17:e0262956.
Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010; 51: (Suppl 1): S81–S87.
Poovieng J, Sakboonyarat B, Nasomsong W. Bacterial etiology and mortality rate in community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia in Thai university hospital. Sci Rep 2022; 12:9004.
Dongol S, Kayastha G, Maharjan N, et al. Epidemiology, etiology, and diagnosis of healthcare acquired pneumonia including ventilator-associated pneumonia in Nepal. PLoS One 2021; 16:e0259634.
Feng DY, Zhou YQ, Zou XL, et al. Differences in microbial etiology between hospital-acquired pneumonia and ventilator-associated pneumonia: a single-center retrospective study in Guang Zhou. Infect Drug Resist 2019; 12:993–1000.
Sader HS, Castanheira M, Arends SJR, et al. Geographical and temporal variation in the frequency and antimicrobial susceptibility of bacteria isolated from patients hospitalized with bacterial pneumonia: results from 20 years of the SENTRY Antimicrobial Surveillance Program (1997–2016). J Antimicrob Chemother 2019; 74:1595–1606.
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399:629–655.
Webb BJ, Dascomb K, Stenehjem E, Dean N. Predicting risk of drug-resistant organisms in pneumonia: moving beyond the HCAP model. Respir Med 2015; 109:1–10.
Hyun H, Song JY, Yoon JG, et al. Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: microbiological distribution, antibiotic resistance, and clinical outcomes. PLoS One 2022; 17:e0270261.
Barreto JV, Dias CC, Cardoso T. Risk factors for community-onset pneumonia caused by drug-resistant pathogens: a prospective cohort study. Eur J Intern Med 2022; 96:66–73.
Blasi F, Garau J, Medina J, et al. Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH. Respir Res 2013; 14:44.
Naidus EL, Lasalvia MT, Marcantonio ER, Herzig SJ. The diagnostic yield of noninvasive microbiologic sputum sampling in a cohort of patients with clinically diagnosed hospital-acquired pneumonia. J Hosp Med 2018; 13:34–37.
Vaz AP, Amorim A, Espinar MJ, et al. Positive bronchoalveolar lavage and quantitative cultures results in suspected late-onset ventilator associated pneumonia evaluation: retrospective study. Rev Port Pneumol 2011; 17:117–123.
Klimko CV, Sanders JM, Monogue ML, et al. Bronchoalveolar lavage Gram stains for early bacterial identification in pneumonia: should they stay or should they go? Crit Care Explor 2021; 3 (8):e0501.
Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015; 373:415–427.
BioFire Diagnostics 2022. The BioFire FilmArray Pneumonia (PN) Panel. https://www.biofiredx.com/products/the-filmarray-panels/filmarray-pneumonia/ [Accessed 12 November 2022]
Curetis GmbH, 2018 | Unyvero HPN Application Manual. https://curetis.com/resources/?resourcelib_category=ifu-manuals#r1 . Last updated: 02/2018. [Accessed 12 November 2022]
Lee SH, Ruan SY, Pan SC, et al. Performance of a multiplex PCR pneumonia panel for the identification of respiratory pathogens and the main determinants of resistance from the lower respiratory tract specimens of adult patients in intensive care units. J Microbiol Immunol Infect 2019; 52:920–928.
Monard C, Pehlivan J, Auger G, et al. Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia. Crit Care 2020; 24:434.
Buchan BW, Windham S, Balada-Llasat JM, et al. Practical comparison of the BioFire FilmArray Pneumonia Panel to routine diagnostic methods and potential impact on antimicrobial stewardship in adult hospitalized patients with lower respiratory tract infections. J Clin Microbiol 2020; 58:e00135–e220.
Zacharioudakis IM, Zervou FN, Dubrovskaya Y, et al. Evaluation of a multiplex PCR panel for the microbiological diagnosis of pneumonia in hospitalized patients: experience from an Academic Medical Center. Int J Infect Dis 2021; 104:354–360.
Peiffer-Smadja N, Bouadma L, Mathy V, et al. Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia. Crit Care 2020; 24:366.
Poole S, Tanner AR, Naidu VV, et al. Molecular point-of-care testing for lower respiratory tract pathogens improves safe antibiotic de-escalation in patients with pneumonia in the ICU: results of a randomised controlled trial. J Infect 2022; 80:1–7.
Darie AM, Khanna N, Jahn K, et al. Fast multiplex bacterial PCR of bronchoalveolar lavage for antibiotic stewardship in hospitalised patients with pneumonia at risk of Gram-negative bacterial infection (Flagship II): a multicentre, randomised controlled trial. Lancet Respir Med 2022; 10:877–887.
Salina A, Schumann DM, Franchetti L, et al. Multiplex bacterial PCR in the bronchoalveolar lavage fluid of nonintubated patients with suspected pulmonary infection: a quasi-experimental study. ERJ Open Res 2022; 8:00595–2021.
Healthcare-associated infections in intensive care units - Annual Epidemiological Report for 2017. European Centre for Disease Prevention and Control. 2019. https://www.ecdc.europa.eu/sites/default/files/documents/AER_for_2017-HAI.pdf . [Accessed 12 November 2022]
Enne VI, Aydin A, Baldan R, et al. Multicentre evaluation of two multiplex PCR platforms for the rapid microbiological investigation of nosocomial pneumonia in UK ICUs: the INHALE WP1 study. Thorax 2022; 77:1220–1228.
Enne VI, Stirling S, Barber J, et al. INHALE WP3: Results of a multicentre randomised controlled trial (INHALE) testing the utility of rapid multiplex PCR at point-of-care for the antibiotic management of hospital-acquired and ventilator-associated pneumonia in critical care. IDWeek 2022: 19—23 October 2022; Washington, DC, USA. Conference proceedings in Open Forum Infectious Diseases (in press).