Other specific DSP article suggested by Editorial Board
Impact of Real-Time Multiplex PCR Testing for Respiratory Viruses on Antibiotic Use.
Authors: Tekin-Taş Z, et al
Abstract
Objective: Real-time multiplex polymerase chain reaction (PCR) test increases the detection of viral respiratory tract infections. This study aimed to evaluate the effect of real-time multiplex PCR on antibiotic use in viral respiratory tract infections.
Materials and methods: This retrospective study included patients who underwent respiratory multiplex PCR tests. Patients were grouped into influenza-like illness, viral pneumonia, bacterial pneumonia, and co-infection. These groups were compared in terms of antibiotic use.
Results: This retrospective study included patients who underwent respiratory multiplex PCR tests. Patients were grouped into influenza-like illness, viral pneumonia, bacterial pneumonia, and co-infection. These groups were compared in terms of antibiotic use.
Conclusion: Despite a confirmed viral etiology by PCR, antibiotic use remained high, particularly in cases of viral pneumonia. These findings underscore the need for targeted antimicrobial stewardship interventions, including clinician education and integration of diagnostic-therapeutic approaches, to optimize antibiotic prescribing in respiratory infections.
Other specific DSP article suggested by Editorial Board
Comparative evaluation of BD MAX Enteric Panels and Luminex NxTAG GPP for the detection of gastrointestinal pathogens in clinical stool samples.
Authors: Guillem J ,et al
Abstract
Purpose: To compare the diagnostic performance of BD MAX™ Enteric Panels and the Luminex NxTAG® Gastrointestinal Pathogen Panel (GPP) for the detection of enteric pathogens under routine clinical conditions.
Methods: A prospective single-center study analyzed 165 stool samples (one per patient) from individuals with suspected gastrointestinal infection attending the Clínico-Malvarrosa Health Department (Valencia, Spain) between October and November 2023. Samples tested using all BD MAX™ enteric panels (bacterial, viral, and Clostridioides difficile panels) were also processed by Luminex NxTAG® GPP assay. Positive Percentage Agreement (PPA), Negative Percentage Agreement (NPA), Cohen’s κ index were calculated. Discrepant results were investigated using the VIASURE real-time PCR and targeted Next-Generation Sequencing, as appropriate.
Results: Among the 165 samples analyzed, 107 (64.8%) were positive for at least one pathogen by either method, with norovirus (n = 40) and Clostridioides difficile (n = 18) being the most frequently detected targets. Overall, both assays exhibited moderate initial agreement (PPA 69.3%, NPA 90.6%, κ = 0.56), with an average PPA of 78.6%. PPA exceeded 85% for most targets, except for sapovirus. Salmonella spp., and Shiga toxin-producing E. coli (stx1, stx2) (STEC) accounted for most discordant results, often associated with low pathogen loads or analytical variability. After discrepancy resolution, both assays demonstrated comparable diagnostic performance, with a substantial concordance of (κ = 0.79 and 0.77, respectively).
Conclusion: BD MAX™ and Luminex NxTAG® GPP demonstrated comparable accuracy in detecting enteric pathogens, supporting their use in cost-effective, culture-independent molecular diagnosis and their integration within microbiological diagnostic stewardship programs.
Other specific DSP article suggested by Editorial Board
Towards personalised empirical antibiotic therapy in febrile neutropenia: a theoretical model based on machine learning and prior colonisation with multidrug-resistant gram-negative bacilli – a retrospective proof-of-concept cohort study.
Authors:Gallardo-Pizarro A, et al
Abstract
Background: Empirical antibiotic therapy (EAT) in febrile neutropenia (FN) remains challenging due to multidrug-resistant (MDR) Gram-negative bacteria, often leading to inappropriate empirical antibiotic therapy (IEAT).
Objective: To demonstrate that risk stratification based on machine learning (ML) and prior colonisation with MDR bacteria may support the tailoring of EAT in patients with haematological malignancies. Design: Retrospective proof-of-concept cohort study.
Methods: All consecutive FN episodes in patients with haematological malignancies were retrospectively included from January 2020 to March 2023 at a tertiary-level university hospital. We compared real-world, clinician-driven empirical antibiotic use with a simulated approach guided by an ML-based risk stratification model combined with prior colonisation data. The main outcomes were antibiotic selection and rates of IEAT.
Results: A total of 553 FN episodes in 398 haematological patients were analysed. Bloodstream infection (BSI) occurred in 141/553 episodes (25.5%). Anti-pseudomonal (PsA) beta-lactams were prescribed in 515/553 episodes (93.1%), with carbapenems in 406/553 (73.4%). The clinician-driven approach resulted in 16/70 (22.9%) GNB-BSI episodes receiving IEAT. The ML plus colonisation-guided approach would have reduced the use of meropenem by 29.7% (-2.08 days; 95% CI, -2.42 to -1.73; p < 0.001) and anti-PsA beta-lactams by 6.7% (-0.47 days; 95% CI, -0.76 to -0.19; p = 0.001), and would also have led to a reduction in the rate of IEAT from 16/70 (22.9%) to 6/70 (8.6%) (p = 0.035). Conclusion: ML-based risk stratification combined with colonisation status would allow for personalised antibiotic therapy in FN, potentially reducing IEAT and improving antimicrobial use. These results support integrating these tools into clinical practice.
Other specific DSP article suggested by Editorial Board
Antimicrobial Stewardship Interventions in Adults with Hospital-acquired Pneumonia: A Systematic Review and Meta-Analysis.
Authors: Ablakimova N, et al
Abstract
Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), represents one of the most severe healthcare-associated infections (HAIs), characterized by high morbidity, mortality, and antimicrobial resistance (AMR) rates.
Aim: To systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological, and process outcomes in adult patients with HAP/VAP.
Methods: A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines (PROSPERO: CRD42023492494). PubMed, Scopus, and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental, and before-after studies involving adults with HAP or VAP. Pooled odds ratios (OR) and standardized mean differences (SMD) were estimated using random effect models in R (meta package).
Findings: Nineteen studies were included, of which eleven were meta-analyzed. ASP interventions significantly reduced the duration of antibiotic therapy (SMD = -1.02; 95% CI: -1.76 to -0.28; p = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26-27.67; p = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51-1.05; p = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73-1.76; p = 0.58), length of ICU stay, or ventilator-free days. Heterogeneity was high across designs.
Conclusion: Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, PK/PD-guided dosing, and ventilator-care bundles within multidisciplinary ICU frameworks.