Antimicrobial Treatment, Bronchoalveolar Lavage, Pneumonia, Sputum
Conditions
Keywords
Bronchoalveolar lavage, Endotracheal Aspirate, Antimicrobial treatment, pneumonia, hcap, pcr multiplex, moleculas syndromic panel, bal, bas, eta, sputum
Brief summary
Prospective Observational Study (on Diagnostic Procedure) - Single-Center, Non-Profit. A pilot study will be conducted on a prospective cohort of patients with HCAP (Healthcare-Associated Pneumonia). This study will be conducted on a single arm of patients. No control group or randomization is planned. The use of syndromic molecular panels in pneumonias with risk factors for MDR (multidrug-resistant) pathogens, such as in patients with HCAP, has become common practice. However, the use of this tool is reserved for patients with severe forms of HCAP (PIRO>2, at least moderate ARDS, and respiratory failure requiring high-flow oxygen during sepsis) (30), and it is not yet standardized by international guidelines. The decision to use this tool or not is currently at the clinician's discretion and is usually reserved for the severe forms mentioned above. The study aims to determine if the early use of this tool has a real benefit on the management of antibiotic therapy for these patients in terms of therapeutic changes compared to corporate and international guidelines. Duration of patient enrollment: 1 year. Duration of the study: 1.5 years.
Interventions
None listed
Sponsors
Azienda Ospedaliero-Universitaria Careggi
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients over the age of 18 who undergo bronchoalveolar lavage (BAL) in the Emergency Department (DEA), with a Rankin score of less than 5, and who are admitted to the Emergency Department with a diagnosis of healthcare-associated pneumonia (HCAP) of bacterial, viral, or fungal origin. The diagnosis must be confirmed by clinical and radiological criteria according to the IDSA guidelines, which include: New pulmonary infiltrate on chest X-ray, Evidence that the infiltrate is of infectious origin, At least two of the following three clinical signs: Fever higher than 38 °C, Leukocytosis or leukopenia, Purulent secretions. Additionally, patients must meet at least one of the following criteria: * Need for high-flow oxygen therapy (VM35 or FiO2 >35%, Reservoir, HFNC, NIV, CPAP) * Intubation (IOT) * SOFA score ≥2 or PSI score >85 (age 75 + IR) * Horowitz index (PaO2/FiO2) < 200
Exclusion criteria
* Lack of consent * Age under 18 or over 90 * Pregnancy * Life expectancy less than 3 months * Hospital admission >48 hours (hospital-acquired pneumonia - HAP) * Rankin score ≥ 5 * Community-acquired pneumonia (CAP)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| evaluate the impact of early use of multiplex PCR | perioperatively/periprocedurally | The primary objective of the study is to evaluate the impact of early use of multiplex PCR on empirical antibiotic therapy. This will be measured by considering the percentage of cases in which the use of multiplex PCR alters the therapy ('escalation' and 'de-escalation') compared to local empirical antibiotic therapy guidelines within 24 hours of hospital admission. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of Hospital Stay | up to 3 months | Assess the total duration of the hospital stay. |
| Need for Escalation of Supportive Therapy: | up to 3 months | Evaluate the necessity for increased supportive therapy, defined as: a) Need for invasive or non-invasive ventilation b) Transfer to a higher level of care c) In-hospital mortality from any cause (complicated course) |
| Duration of Antibiotic Therapy: | up to 3 months | Track the length of time antibiotics are administered. |
| De-escalation of Antibiotic Therapy | 7 days from admission | Assess the de-escalation of antibiotic therapy within the first 7 days of inclusion in the study. |
| Time to Antibiotic Escalation or De-escalation | up to 3 months | Measure the time from hospital admission to the escalation or de-escalation of antibiotic therapy. |
| Identification of HCAP Etiology | 7 days from admission | Determine the cause of HCAP within the first 7 days of inclusion using all methods: multiplex PCR, culture tests, antigen detection, and serology. |
| In-hospital Mortality | up to 3 months | Measure in-hospital mortality rates for pneumonia and all causes. |
| 30-day Mortality and Readmission | 30 days from discharge | Measure mortality rates for pneumonia and all causes, and track readmissions within 30 days. |
| Escalation of Antibiotic Therapy | 7 days from admission | Assess the escalation of antibiotic therapy within the first 7 days of inclusion in the study. |
Countries
Italy
Contacts
Primary ContactPelagatti Lorenzo, Dr
Backup ContactPelagatti Lorenzo, Dr
Outcome results
None listed