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Master Thesis

Intérêt de la PCR multiplex Unyvero dans le diagnostic précoce des pneumopathies acquises sous ventilation mécanique, et dans la stratégie d'épargne des antibiotiques

Abstract : Introduction: Mechanically acquired pneumopathy (VAP) is a major problem in intensive care units (ICU). This pathology is not only common, but also grave and requires complex diagnosis. Standard microbiology techniques are slow (48 to 72 hours). Broad-spectrum probabilistic processing, often introduced as a result of expecting quicker results, causes an emergence of multi-resistant bacteria. The multiplexPCR Unyvero Pneumonia allows rapid detection of pathogens frequently involved in low respiratory tract infections and targets 19 resistance mechanisms. The aim of this study was to analyze the diagnostic performance of multiplex PCR and its interest in the strategy of limiting antibiotic use in intensive care units. Material and method: The sample population consisted of patients hospitalized in intensive care with a diagnosis of VAP. All patients were included prospectively. Respiratory samples were sent to standard microbiology and analyzed using Unyvero multiplex PCR. We studied the concordance of the results between the two techniques. For each patient, we analyzed what impact the knowledge of the results of the PCR could have had on the antibiotherapy started in probabilistic. Results: Between November 2016 and November 2017, 60 patients were included in the study, mostly men (63%). The median age was 61 years, the average IGS II at admission 56. Only 18 patients had a CPIS score> 6. Among the 60 patients, 41 had received the antibiotics as soon as the microbiological sampling was done. In 23 patients (38%), the diagnosis of VAP was retained at the time of resuscitation. The perfect match between multiplex PCR and standard microbiology in our study is 73%. Seven analyzes of the multiplex PRC were subject to a technical error. The sensitivity and specificity of the multiplex PCR are both 86% with 95% confidence intervals of (70-100%) and (75-97%), respectively. The positive predictive value is 78% (61-95%) and the negative predictive value is 91% (82-100%). We find the best diagnostic performance for non fermenting GNB with sensitivity of 87% (64-110%) and specificity of 97% (93-101%). The lowest sensitivity of 75% (32-117%) is found for Group 3 Enterobacteriaceae. The specificity is greater than 90% for all bacteria studied. The kappa approval coefficient varies between 0.60 and 0.85. In 71% of cases, antibiotic resistance was correctly detected by multiplex PCR. Knowledge of the results of the multiplex PCR would have influenced the choice of antibiotic therapy in 35 cases (58%). Conclusion: Multiplex PCR could be an efficient and fast alternative to standard microbiology. This technique seems to be an interesting tool in the earlier diagnosis of VAP and antibiotic savings policy in intensive care units. Nevertheless, the monocentric nature and the low number of samples are limiting factors for the extrapolation of our results. A study of a larger workforce must be conducted in order to confirm these results.
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Master Thesis
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Monika Muszynska. Intérêt de la PCR multiplex Unyvero dans le diagnostic précoce des pneumopathies acquises sous ventilation mécanique, et dans la stratégie d'épargne des antibiotiques. Chirurgie. 2018. ⟨dumas-02484939⟩

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