Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in context
Summary: Background: Respiratory infection may account for 30% of acute chest syndrome (ACS) aetiologies. However, antimicrobials are routinely prescribed, and de-escalation and/or discontinuation are challenging. Multiplex Polymerase Chain Reaction (mPCR) with an enlarged respiratory panel might s...
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Elsevier
2025-04-01
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| Series: | The Lancet Regional Health. Europe |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776225000262 |
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| author | Alexandre Sabaté-Elabbadi Armand Mekontso-Dessap François Lionnet Aline Santin Charlotte Verdet Paul-Louis Woerther Julien Lopinto Matthieu Turpin Alexandra Rousseau Romane Lacoste-Badie Keyvan Razazi Guillaume Voiriot Muriel Fartoukh |
| author_facet | Alexandre Sabaté-Elabbadi Armand Mekontso-Dessap François Lionnet Aline Santin Charlotte Verdet Paul-Louis Woerther Julien Lopinto Matthieu Turpin Alexandra Rousseau Romane Lacoste-Badie Keyvan Razazi Guillaume Voiriot Muriel Fartoukh |
| author_sort | Alexandre Sabaté-Elabbadi |
| collection | DOAJ |
| description | Summary: Background: Respiratory infection may account for 30% of acute chest syndrome (ACS) aetiologies. However, antimicrobials are routinely prescribed, and de-escalation and/or discontinuation are challenging. Multiplex Polymerase Chain Reaction (mPCR) with an enlarged respiratory panel might support antimicrobial stewardship, and procalcitonin (PCT) measurements help reduce duration of antibiotic therapy. We hypothesized that a strategy combining the use of mPCR with repeated PCT measurements would reduce antibiotic exposure during ACS. Methods: We conducted a randomised, controlled, parallel group, open-label study in two French hospitals. Consecutive adult patients with ACS were randomly assigned to the conventional or interventional strategy, where antibiotic therapy was targeted on the results of mPCR performed on lower respiratory tract secretions (LRTS) samples, and antibiotic discontinuation based on PCT values and kinetics at Day 1 (D1), D3 and D7. The primary outcome was the number of days of antibiotic exposure at D28 after randomisation. This trial was registered on ClinicalTrial.gov (NCT03919266) and is closed to recruitment. Findings: From June 2020 to September 2022, 72 patients were assigned to the interventional (n = 37) or conventional strategy (n = 35). Despite a higher rate of microbiological documentation with the intervention (n = 25; 67.6% versus n = 13; 37.1%; difference, 30.4%; 95% CI 6.7%–51.5%), antibiotic exposure at D28 was similar between the two strategies (6 days [4.0–8.0] versus 6 days [5.0–9.0], respectively; difference, 0.0 day; 95% CI, −2.1 to 2.1). The time to clinical stability, and ICU and hospital lengths of stay did not differ. Interpretation: As compared with conventional tests, an enlarged respiratory panel mPCR combined with a PCT-guided algorithm did not reduce antibiotic exposure at D28 in adults with ACS. Funding: Assistance Publique—Hôpitaux de Paris, AP-HP (CRC180159). A financial support for the multiplex PCR kits used in this study was partially provided by bioMérieux. |
| format | Article |
| id | doaj-art-099846437309441799bf03334ec09798 |
| institution | Kabale University |
| issn | 2666-7762 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Europe |
| spelling | doaj-art-099846437309441799bf03334ec097982025-02-08T05:01:25ZengElsevierThe Lancet Regional Health. Europe2666-77622025-04-0151101234Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in contextAlexandre Sabaté-Elabbadi0Armand Mekontso-Dessap1François Lionnet2Aline Santin3Charlotte Verdet4Paul-Louis Woerther5Julien Lopinto6Matthieu Turpin7Alexandra Rousseau8Romane Lacoste-Badie9Keyvan Razazi10Guillaume Voiriot11Muriel Fartoukh12Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, FranceHôpitaux universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, IMRB GRC CARMAS, 94010, Créteil, FranceSorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Médecine Interne, Hôpital Tenon, Paris, FranceSorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Médecine Interne, Hôpital Tenon, Paris, FranceSorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Bactériologie, Hôpital Saint-AntoineHôpitaux universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris, Service de Microbiologie, Hôpital Henri Mondor, Créteil, FranceSorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France; Hôpitaux universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, IMRB GRC CARMAS, 94010, Créteil, FranceSorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, FranceAssistance Publique – Hôpitaux de Paris, Unité de Recherche Clinique de l’Est Parisien (URC-EST), Hôpital Saint-Antoine, Paris, FranceAssistance Publique – Hôpitaux de Paris, Unité de Recherche Clinique de l’Est Parisien (URC-EST), Hôpital Saint-Antoine, Paris, FranceHôpitaux universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, IMRB GRC CARMAS, 94010, Créteil, FranceSorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France; Centre de Recherche Saint-Antoine UMRS_938 INSERM, Paris, FranceSorbonne Université, Assistance Publique – Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, IMRB GRC CARMAS, 94010, Créteil, France; Corresponding author. Service de Médecine Intensive Réanimation, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.Summary: Background: Respiratory infection may account for 30% of acute chest syndrome (ACS) aetiologies. However, antimicrobials are routinely prescribed, and de-escalation and/or discontinuation are challenging. Multiplex Polymerase Chain Reaction (mPCR) with an enlarged respiratory panel might support antimicrobial stewardship, and procalcitonin (PCT) measurements help reduce duration of antibiotic therapy. We hypothesized that a strategy combining the use of mPCR with repeated PCT measurements would reduce antibiotic exposure during ACS. Methods: We conducted a randomised, controlled, parallel group, open-label study in two French hospitals. Consecutive adult patients with ACS were randomly assigned to the conventional or interventional strategy, where antibiotic therapy was targeted on the results of mPCR performed on lower respiratory tract secretions (LRTS) samples, and antibiotic discontinuation based on PCT values and kinetics at Day 1 (D1), D3 and D7. The primary outcome was the number of days of antibiotic exposure at D28 after randomisation. This trial was registered on ClinicalTrial.gov (NCT03919266) and is closed to recruitment. Findings: From June 2020 to September 2022, 72 patients were assigned to the interventional (n = 37) or conventional strategy (n = 35). Despite a higher rate of microbiological documentation with the intervention (n = 25; 67.6% versus n = 13; 37.1%; difference, 30.4%; 95% CI 6.7%–51.5%), antibiotic exposure at D28 was similar between the two strategies (6 days [4.0–8.0] versus 6 days [5.0–9.0], respectively; difference, 0.0 day; 95% CI, −2.1 to 2.1). The time to clinical stability, and ICU and hospital lengths of stay did not differ. Interpretation: As compared with conventional tests, an enlarged respiratory panel mPCR combined with a PCT-guided algorithm did not reduce antibiotic exposure at D28 in adults with ACS. Funding: Assistance Publique—Hôpitaux de Paris, AP-HP (CRC180159). A financial support for the multiplex PCR kits used in this study was partially provided by bioMérieux.http://www.sciencedirect.com/science/article/pii/S2666776225000262Acute chest syndromeSickle cell anemiaMultiplex polymerase chain reactionProcalcitoninAnti-bacterial agents |
| spellingShingle | Alexandre Sabaté-Elabbadi Armand Mekontso-Dessap François Lionnet Aline Santin Charlotte Verdet Paul-Louis Woerther Julien Lopinto Matthieu Turpin Alexandra Rousseau Romane Lacoste-Badie Keyvan Razazi Guillaume Voiriot Muriel Fartoukh Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in context The Lancet Regional Health. Europe Acute chest syndrome Sickle cell anemia Multiplex polymerase chain reaction Procalcitonin Anti-bacterial agents |
| title | Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in context |
| title_full | Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in context |
| title_fullStr | Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in context |
| title_full_unstemmed | Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in context |
| title_short | Combined use of respiratory multiplex PCR and procalcitonin to reduce antibiotic exposure in sickle-cell adult patients with acute chest syndrome (The ANTIBIO-STA study): a randomised, controlled, open-label trialResearch in context |
| title_sort | combined use of respiratory multiplex pcr and procalcitonin to reduce antibiotic exposure in sickle cell adult patients with acute chest syndrome the antibio sta study a randomised controlled open label trialresearch in context |
| topic | Acute chest syndrome Sickle cell anemia Multiplex polymerase chain reaction Procalcitonin Anti-bacterial agents |
| url | http://www.sciencedirect.com/science/article/pii/S2666776225000262 |
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