Your browser does not support JavaScript!

Home    Search  

Results - Details

Search command : Author="Βαπορίδη"  And Author="Αικατερίνη"

Current Record: 1 of 19

Back to Results Previous page
Next page
Add to Basket
[Add to Basket]
Identifier 000455119
Title Μελέτη καινοτόμων μεθόδων ταχείας μικροβιολογικής διάγνωσης πνευμονίας σχετιζόμενης με μηχανικό αερισμό
Alternative Title Study of innovative methods of rapid microbiological diagnosis of ventilator acquired pneumonia
Author Σταφυλάκη, Δήμητρα
Thesis advisor Χαμηλός, Γεώργιος
Reviewer Γεωργόπουλος, Δημήτριος
Βαπορίδη Αικατερίνη
Abstract SUMMARY Introduction Lower respiratory tract infections remain a leading cause of death worldwide. Furthermore, ventilator associated pneumonia (VAP) is a major cause of prolonged length of stay and poor outcome of patients in the Intensive Care Unit (ICU). Timely initiation of appropriate antibiotic therapy is the most critical determinant of the outcome of patients with severe community acquired pneumonia (CAP), health care associated pneumonia (HAP) and VAP. Nonetheless, empirical selection of antimicrobial therapy and optimal management of severe CAP, HAP and VAP is challenging, because of the emergence of multi- and/or pan-drug resistant (MDR/PDR) nosocomial pathogens. Molecular syndromic platforms are increasingly utilized in diagnosis of infectious diseases as a mean to improve etiological diagnosis and reduce antibiotic consumption through pathogen-guided empirical antimicrobial therapy. The present study evaluated the performance of a molecular syndromic platform (BioFire FilmArray -Pneumonia plus Panel) in the management of lower respiratory tract infections caused by MDR/XDR pathogens in the ICU. Methods Eligible for enrollment to the study were all patients admitted in the ICU of University Hospital of Heraklion, Crete between June 2018 and June 2020 with severe CAP/HAP or those who developed VAP during ICU stay. Inclusion criteria were 1) age> 18 years, 2) presence of clinical and radiological criteria for pneumonia according to the IDSA guidelines: new lung infiltrate on a chest X-ray and evidence that the infiltrate was of an infectious origin, i.e., at least two of three clinical features (fever greater than 38°C, leukocytosis or leukopenia, and purulent secretions), and 3) severe respiratory failure requiring ICU admission and mechanical ventilation. The following exclusion criteria were included (i) ICU patients with fever of another etiology, (ii) colonization of the lung or ventilator associated tracheobronchitis (VAT), (iii) patient already enrolled in the study, and (iv) patients on palliative care. Endotracheal aspirates were obtained from all the patients at the time of clinical indication of pneumonia and tested simultaneously, using conventional microbiological techniques and the PCR BioFire FilmArray Pneumonia Panel (bioMérieux S.A., France). Clinical and demographical characteristics were retrospectively obtained from the electronic medical records of each patient. Results We enrolled 79 consecutive critically ill patients diagnosed with different type of pneumonia (sCAP/HAP or VAP) in the ICU and compared them with an historical control group (n=40) of patients with pneumonia in the ICU during the year before the study (2017-2018). VAP comprised almost 2/3 of cases of pneumonia in both study groups. There were no significant differences in demographic and clinical characteristics of the patients, including median age, co-morbidities, and severity of illness as evidenced by APACHE II and SOFA score (on day 1). Importantly, we found no significant differences in the outcome, including mean number of days of hospitalization in the ICU and mortality rates, between the two groups of patients. Compared the results of syndromic PCR versus conventional culture of tracheal aspirates in the PCR group, we found that the syndromic PCR test was in agreement in 40 % of the cases, improved diagnosis in 49% of the cases and in11% of the cases the pathogens were identified only in culture, because the corresponding microbial targets were not included in the syndromic PCR panel. In regard to the impact of syndromic PCR on antibiotic usage (expressed in DDD/100 BD) we found a significant reduction in the use of antimicrobials targeting MDR/XDR pathogens, including colistin, tigecycline, and carbapenems in the study group versus the historical control group. Additionally, the molecular syndromic test significantly improved time to diagnosis versus conventional culture (3.5 h vs 72 h, P < 0.0001). Conclusions The implementation of syndromic molecular diagnosis in critically ill patients with pneumonia is associated with timely and improved diagnosis and has significant impact on reduction of antibiotic consumption.
Language Greek, English
Subject Antibiotic consumption
Antibiotic stewwardship
Multidrug resistant
Pandrug resistant
Μικροβιοτική επιτήρηση
Μοριακή διάγνωση
Πνευμονία αναπνευστήρα
Στοχευμένη θεραπεία
Φασματομετρία μάζας
Issue date 2023-07-28
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
Permanent Link https://elocus.lib.uoc.gr//dlib/1/8/e/metadata-dlib-1686727101-961915-24927.tkl Bookmark and Share
Views 661

Digital Documents
No preview available

Download document
View document
Views : 0