Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study

Giacobbe, D. R.; Cattardico, G.; Bartalucci, C.; Di Pilato, V.; Muccio, M.; Limongelli, A.; Signori, A.; Bandera, A.; Cacopardo, B.; Campanella, E.; Caroli, A.; Cattelan, A.; Colaneri, M.; Cortegiani, A.; Curci, L.; De Pascale, G.; De Socio, G. V.; Del Puente, F.; Di Fede, A.; Fanelli, C.; Geremia, N.; Giannella, M.; Grasselli, G.; Maci, C.; Maida, I.; Mangioni, D.; Marino, A.; Mazzitelli, M.; Meloni, M. C.; Merli, M.; Momesso, E.; Oltolini, C.; Pallotto, C.; Panese, S.; Passerini, M.; Pontali, E.; Riccucci, D.; Rinaldi, M.; Ripa, M.; Scaglione, V.; Serino, F. S.; Spagnuolo, V.; Spurio, G.; Tigano, S.; Torti, C.; Travi, G.; Magnasco, L.; Portunato, F.; Briano, F.; Mikulska, M.; Ball, L.; Robba, C.; Patroniti, N.; Battaglini, D.; Giacomini, M.; Rossolini, G. M.; Sanguinetti, M.; Morici, P.; Marchese, A.; Vena, A.; Bassetti, M.; RAPID-SITA PHENOTYPES investigators,; Viale, P.; Ippolito, M.; Giarratano, A.; Di Maio, M.; Catalisano, G.; Monardo, R.; Castagna, A.; Potenza, E.; Boffa, N.; Tomasello, M.; Peri, C.; Muscatello, A.; Lombardi, A.; Posteraro, B.; Del Giacomo, P.; Cammarota, F.; Grignolo, S.; Garlaschelli, A.; Parisini, A.; Bobbio, N.; Malincarne, L.; Gidari, A.; Gonnelli, G.; Simoncini, E.; Sassi, S.; D'Amico, F.; Piscaglia, M.; Gullotta, C.; Cosentino, F.; Gallone, S.; Antola, S.; De Paola, L.; Lamarina, A.; Viglietti, G.; Di Biagio, A.; Rosso, N.; Mora, S.; Piana, M.; Campi, C.; Guastavino, S.; Cappello, A.; Di Meco, G.; Murgia, Y.

doi:10.1186/s13054-025-05632-z

Background Ventilator-associated bacterial pneumonia (VABP) is a common infection in critically ill patients in intensive care units (ICU), with attributable mortality of up to 13%, and its etiological diagnosis remains challenging. Materials and methods We conducted a multicenter, prospective, observational study within the MULTI-SITA platform to assess the impact on relevant clinical and antimicrobial stewardship outcomes of the use of a molecular syndromic panel (BIOFIRE (R) FILMARRAY (R) Pneumonia plus), in addition to a standard approach based on culture.The primary outcome measure was 30-day mortality from VABP onset. Results Overall, 237 patients with VABP were included in the study. In multivariable analysis, SOFA score (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.04-1.22, p = 0.003), previous isolation of carbapenem-resistant Pseudomonas aeruginosa (HR 3.02, 95% CI 1.25-7.32, p = 0.015), and solid neoplasm (HR 2.15, 95% CI 1.12-4.14, p = 0.022) were associated with increased mortality, while no association was registered for the molecular syndromic panel performed (HR 1.07, 95% CI 0.59-1.93, p = 0.825). In secondary analyses, use of the molecular syndromic panel resulted in more events of either de-escalation or initiation of appropriate antibiotic therapy at day 1 from VABP onset in comparison with a standard approach based on culture only (41.3% vs. 27.8%, p = 0.041). Conclusion The use of a molecular syndromic panel in patients with VABP was able to impact antibiotic decisions, without an unfavorable effect on mortality. Further study is necessary to assess the long-term effects in terms of antimicrobial stewardship of molecular syndromic panels-based antibiotic treatment decisions.