Diagnostic Performance and Impact on Antimicrobial Treatment of a Multiplex Polymerase Chain Reaction in Critically Ill Patients With Pneumonia: A Multicenter Observational Study (The MORICUP-PCR Study: Morocco ICU Pneumonia-PCR study)

Younes Aissaoui, MD; Ali Derkaoui, MD; Abdelhamid Hachimi, MD; Ayoub Bouchama, MD; Tarek Dendane, MD; Mouhssine Doumiri, MD; Karim ElAidaoui, MD; Amra Ziadi, MD; Meryem Essafti, MD; Latifa Oualili, MD; Mehdi Khaddouri, MD; Oumaima Mroune, MD; Mehdi Oudrhiri Safiani, MD; Mohammed Khallouki, MD; Adnane Berdai, MD; Brahim Boukatta, MD; Ahmed Rhassane El Adib, MD; Naoufel Madani, MD; Nabila Soraa, MD; Ayoub Belhadj, MD; Jamal Eddine Kohen, MD; Redouane Abouqal, MD

doi:10.1097/CCE.0000000000001220

Critical Care Explorations (Feb 2025)

Diagnostic Performance and Impact on Antimicrobial Treatment of a Multiplex Polymerase Chain Reaction in Critically Ill Patients With Pneumonia: A Multicenter Observational Study (The MORICUP-PCR Study: Morocco ICU Pneumonia-PCR study)

Younes Aissaoui, MD,
Ali Derkaoui, MD,
Abdelhamid Hachimi, MD,
Ayoub Bouchama, MD,
Tarek Dendane, MD,
Mouhssine Doumiri, MD,
Karim ElAidaoui, MD,
Amra Ziadi, MD,
Meryem Essafti, MD,
Latifa Oualili, MD,
Mehdi Khaddouri, MD,
Oumaima Mroune, MD,
Mehdi Oudrhiri Safiani, MD,
Mohammed Khallouki, MD,
Adnane Berdai, MD,
Brahim Boukatta, MD,
Ahmed Rhassane El Adib, MD,
Naoufel Madani, MD,
Nabila Soraa, MD,
Ayoub Belhadj, MD,
Jamal Eddine Kohen, MD,
Redouane Abouqal, MD

Affiliations

Younes Aissaoui, MD: 1 Department of Critical Care Medicine, Avicenna Military Hospital, Marrakesh, Morocco.
Ali Derkaoui, MD: 3 Department of Anesthesiology and Intensive Care, Hassan II University Hospital, Fez, Morocco.
Abdelhamid Hachimi, MD: 4 Medical Intensive Care Unit, Mohammed VI University Hospital, Cadi Ayyad University, Marrakesh, Morocco.
Ayoub Bouchama, MD: 1 Department of Critical Care Medicine, Avicenna Military Hospital, Marrakesh, Morocco.
Tarek Dendane, MD: 5 Medical Intensive Care Unit, Ibn Sina University Hospital, Faculty of Medicine, Mohammed V University, Rabat, Morocco.
Mouhssine Doumiri, MD: 6 Department of Neurocritical Care, Neurocritical Care Unit, Rabat Specialty Hospital, Mohammed V University, Rabat, Morocco.
Karim ElAidaoui, MD: 7 Department of Anesthesiology and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, Morocco.
Amra Ziadi, MD: 8 Surgical Intensive Care Unit, Mohammed VI University Hospital, Cadi Ayyad University, Marrakech, Morocco.
Meryem Essafti, MD: 9 Obstetrics and Gynecology Anesthesia and Intensive Care Department, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Latifa Oualili, MD: 5 Medical Intensive Care Unit, Ibn Sina University Hospital, Faculty of Medicine, Mohammed V University, Rabat, Morocco.
Mehdi Khaddouri, MD: 3 Department of Anesthesiology and Intensive Care, Hassan II University Hospital, Fez, Morocco.
Oumaima Mroune, MD: 3 Department of Anesthesiology and Intensive Care, Hassan II University Hospital, Fez, Morocco.
Mehdi Oudrhiri Safiani, MD: 6 Department of Neurocritical Care, Neurocritical Care Unit, Rabat Specialty Hospital, Mohammed V University, Rabat, Morocco.
Mohammed Khallouki, MD: 11 Department of Anesthesia and Intensive Care Medicine, Ibn Tofail Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.
Adnane Berdai, MD: 12 Mother and Child Intensive Care Unit, Hassan II University Hospital Center, Fez, Morocco.
Brahim Boukatta, MD: 13 General Intensive Care Unit A4, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
Ahmed Rhassane El Adib, MD: 9 Obstetrics and Gynecology Anesthesia and Intensive Care Department, Mother and Child Hospital, Mohammed VI University Hospital, Marrakech, Morocco.
Naoufel Madani, MD: 15 Department of Critical Care, National Oncology Institute, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
Nabila Soraa, MD: 16 Laboratory of Microbiology, Mohamed VI University Hospital, Cadi Ayyad University, Marrakesh, Morocco.
Ayoub Belhadj, MD: 1 Department of Critical Care Medicine, Avicenna Military Hospital, Marrakesh, Morocco.
Jamal Eddine Kohen, MD: 17 Moroccan Network for Infectious Diseases Research in Critical Care (REMARIR), Moroccan Society of Anesthesia Analgesia and Intensive Care.
Redouane Abouqal, MD: 19 Laboratory of Biostatistics, Clinical, and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.

DOI: https://doi.org/10.1097/CCE.0000000000001220
Journal volume & issue: Vol. 7, no. 2
p. e1220

Abstract

Read online

OBJECTIVES:. Managing severe pneumonia remains a challenge. Rapid diagnostic tests, such as multiplex polymerase chain reaction (mPCR), facilitate quick microorganism identification and may enable timely and appropriate antimicrobial therapy. However, studies from low-income countries are scarce. This study aimed to evaluate the diagnostic characteristics of mPCR and its impact on antibiotic therapy and outcomes in critically ill patients with pneumonia. DESIGN:. Multicenter observational study. SETTING:. Twelve ICUs across Morocco. PATIENTS:. Adult patients with pneumonia requiring invasive mechanical ventilation, including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Respiratory samples were analyzed using both mPCR and conventional microbiological methods. The diagnostic performance of mPCR was evaluated, including its sensitivity and specificity. Additionally, the appropriateness of mPCR-induced modifications in empiric antibiotic therapy and their impact on patient outcomes were assessed. A total of 210 patients were included, with a median age of 50 years (range, 33–67 yr), of whom 66.2% were male. Pneumonia types were distributed as 30% CAP, 58% VAP, and 12% HAP. mPCR demonstrated a sensitivity of 96.9% (95% CI, 92.3–99.2%) and a specificity of 92% (95% CI, 91–93%). Following mPCR, antibiotic therapy modifications were observed in 58% of patients (n = 122), including de-escalation or cessation in 11% (n = 23), escalation in 26.5% (n = 56), adequacy adjustments in 7.5% (n = 16), and initiation of antibiotics in 13% (n = 27). The appropriateness of antibiotic therapy increased significantly from 38.7% (n = 83) to 67% (n = 141; difference, 27.5%; 95% CI, 18.3–36.7; p < 0.0001). Generalized mixed model analysis revealed that appropriate post-mPCR antibiotic therapy was associated with reduced mortality (adjusted odds ratio, 0.37; 95% CI, 0.15–0.93; p = 0.038). CONCLUSIONS:. Our findings suggest that the use of mPCR is associated with a significant improvement in the appropriateness of empiric antibiotic therapy and is also associated with a positive impact on the outcome of patients with pneumonia.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

About the journal