Dhesi, Zaneeta;
(2021)
Rapid Diagnosis and Treatment of Hospital-acquired and Ventilator-associated Pneumonia in Intensive Care Unit Patients.
Doctoral thesis (M.D (Res)), UCL (University College London).
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Abstract
Background. This study aimed to define pathogens causing hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) using the polymerase chain reaction (PCR) based FilmArray™ Pneumonia Panel Plus (BioFire Torch system); and determine its potential in antimicrobial stewardship alongside a bespoke prescribing algorithm. The FilmArray™ panel, used on lower respiratory tract samples, includes 34 bacteria/viruses/resistance gene targets. Methods. FilmArray™ results and conventional diagnostic sputum results were analysed for participating intensive care unit (ICU) patients with clinically-suspected HAP/VAP from 12 UK hospitals. Antibiotic prescribing and adherence to the prescribing algorithm were evaluated. Comparisons were made between COVID-19 and non-COVID-19 patients. Results. The study included 326 patients; 126 were COVID-19 positive. 112 FilmArray™ tests were available for 104 non-COVID-19 adult patients; 44 FilmArray™ tests for 44 paediatric patients; 157 FilmArray™ tests for 126 COVID-19 adult patients. Amongst the non-COVID-19 group the most common organism was Haemophilus influenzae (n=23), followed by Staphylococcus aureus (n=20). Significantly more viruses were identified amongst children (P<0.0001). The proportion of negative result samples amongst conventional diagnostic microbiology results (50.7%) was significantly higher than for FilmArray™ (36.6%); P=0.024. The most common organism in COVID-19 patients was Klebsiella pneumoniae (n=30); its prevalence significantly higher than in non-COVID-19 patients (P=0.005). In both patient groups approximately one third of patients’ antibiotics adhered to the prescribing algorithm. A negative FilmArray™ result, in COVID-19 patients, was associated with stopping more antibiotics, compared to non-COVID-19 patients: 95% CI: 1.0%, 28.2%; and with significantly more patients not starting antibiotics: 95% CI: 8.8%, 33.6%. Significantly more COVID-19 patients had antibiotics stopped after a positive FilmArray™ result: 95% CI: 2.3%, 19.4%. Conclusions. Klebsiella spp. were more prevalent in COVID-19 patients than in a similar pre-pandemic population. FilmArray™ identified more bacteria than conventional diagnostic microbiology, and there was evidence for its use as an antimicrobial stewardship tool – especially amongst COVID-19 patients.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D (Res) |
| Title: | Rapid Diagnosis and Treatment of Hospital-acquired and Ventilator-associated Pneumonia in Intensive Care Unit Patients |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10140288 |
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