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Background: Improving timeliness of pathogen identification is crucial to allow early adaptation of antibiotic therapy and improve prognosis in patients with pneumonia. We evaluated the relevance of a new syndromic rapid multiplex PCR test (rm-PCR) on respiratory samples to guide empirical antimicrobial therapy in adult patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP).Methods: This retrospective multicenter study was conducted in four French university hospitals. Respiratory samples were obtained from patients with clinical and radiological signs of pneumonia and simultaneously tested using conventional microbiological methods and the rm-PCR. A committee composed of an intensivist, a microbiologist, and an infectious diseases specialist retrospectively assessed all medical files and agreed on the most appropriate antimicrobial therapy for each pneumonia episode, according to the results of rm-PCR and blinded to the culture results. The rm-PCR-guided antimicrobial regimen was compared to the empirical treatment routinely administered to the patient in standard care.Results: We included 159 pneumonia episodes. Most patients were hospitalized in intensive care units (n = 129, 81%), and episodes were HAP (n = 68, 43%), CAP (n = 54, 34%), and VAP (n = 37, 23%). Conventional culture isolated ≥ 1 microorganism(s) at significant level in 95 (60%) patients. The syndromic rm-PCR detected at least one bacteria in 132 (83%) episodes. Based on the results of the rm-PCR, the multidisciplinary committee proposed a modification of the empirical therapy in 123 (77%) pneumonia episodes. The modification was a de-escalation in 63 (40%), an escalation in 35 (22%), and undetermined in 25 (16%) patients. In microbiologically documented episodes (n = 95), the rm-PCR increased appropriateness of the empirical therapy to 83 (87%), as compared to 73 (77%) in routine care.Conclusions: Use of a syndromic rm-PCR test has the potential to reduce unnecessary antimicrobial exposure and increase the appropriateness of empirical antibiotic therapy in adult patients with pneumonia. [ABSTRACT FROM AUTHOR]

Résumé: Bien que moins fréquente et moins grave qu'en hématologie, la neutropénie fébrile (NF) reste l'un des effets secondaires les plus sévères des chimiothérapies pour cancer solide. Sa prise en charge doit être stéréotypée : i) identification précoce des signes de gravité ; ii) recherche d'un foyer infectieux clinique et prélèvement systématique d'hémocultures ; iii) administration dans l'heure qui suit le début de la prise en charge de la première dose d'antibiothérapie probabiliste ; iv) évaluation de la possibilité d'une prise en charge en ambulatoire grâce à l'aide de scores dorénavant bien validés. En ambulatoire, il est recommandé d'associer une fluoroquinolone à l'amoxicilline-acide clavulanique comme traitement probabiliste. Les traitements antibiotiques en hospitalisation dépendent de la situation clinique. Qu'ils soient hospitalisés ou traités en ambulatoire, l'état clinique des patients doit faire l'objet de réévaluation régulière afin de pouvoir adapter au plus vite le traitement antibiotique qu'ils reçoivent. Grâce à cette démarche stéréotypée, les patients se verront offrir une prise en charge en cas de NF, parfaitement sécurisée et la moins contraignante possible, le recours à l'hospitalisation n'étant pas systématique. Although less frequent and severe than in hematological setting, febrile neutropenia (FN) is one of the most feared complication following chemotherapy for solid cancer. Its management has to be stereotyped: i) early detection of life-threatening organ dysfunction; ii) complete history and physical examination to identify infectious foci and systematic blood-cultures sample; iii) administration of the first dose of empirical antibiotherapy within the first hour after initial presentation; iv) identification of patients candidates for outpatient management. An oral fluoroquinolone plus amoxicillin/clavulanate is recommended as empirical outpatient therapy. Different types of antibiotic treatments are recommended for hospitalized patients, according to the patients' clinical presentation. Whether they are hospitalized or not, patients' clinical condition must be reassessed regularly in order to adapt the antimicrobial therapy if they remain febrile. Thanks to this systematic approach, management of patients with NF can be perfectly safe even for patients eligible for outpatient management. [ABSTRACT FROM AUTHOR]

Competing Interests: P. Tattevin déclare des interventions ponctuelles et/ou des prises en charge lors de congrès par Astellas, AstraZeneca, Aventis, Bristol-Myers- Squibb, Galderma, Gilead Sciences, Janssen-Cilag, MSD, Novartis, Pfizer, The Medicines Company et ViiV-Healthcare. M. Baldeyrou déclare n’avoir aucun lien d’intérêts. M. Revest déclare des interventions ponctuelles pour Astellas et Novartis.