42nd International Symposium on Intensive Care & Emergency Medicine

Abstract

Introduction: Ventilator associated pneumonia (VAP) is a nosocomial infection with high associated morbidity and mortality. Timely, accurate diagnosis of VAP and appropriate antibiotic therapy can impact outcomes. The disease itself is poorly defined and diagnosis often limited by low yield sampling techniques and delays in growth of microbiological samples. The use of rapid diagnostics such as BioFire VAP FilmArray have shown promise in reducing time to identification of pathogen, with hopes this may lead to more targeted antibiotic therapy. However, the benefit of this is unclear and relies on ICU clinicians having trust in the sampling technique and test itself. There Is a signficant cost burden to the test which on our unit was part of a routine order-set in patients suspected of VAP. We aimed to reduce uncessary sample through a QI process. Methods: We performed a retrospective analysis of clinical data from electronic health records of all patients admitted to our ICU between December 2021 to January 2022, and then a repeat analysis post intervention between December 2022. All patients ventilated greater than 48 h were included for analysis. Data on length of stay, mortality, duration of antibiotics, number of BioFire samples sent, and change to therapy post test were recorded. Results: BioFire lead to a change in therapy in 21% of patients. This was an escalation of antibiotics 66% of the time. The test never led to a cessation of antibiotic therapy. Following intervention (a package of education and removal of the test from our routine order set) there was an 90% reduction in unnecessary sampling. There was no significant change to duration of antibiotic, ICU length of stay or mortality in patients diagnosed as VAP following the change. Conclusions: The use of BioFire FilmArray tests rarely led to a clinical change on our unit. Removing the test from a routine order set did not seem to have a significant clinical impact. More work Is required to assess their use as an microbial stewardship tool.