Multiplex PCR-pneumonia panel: usefulness and cost-considerations in a post-transplant cohort in a lower middle-income country

Abstract

Introduction: Post-transplant pneumonia is a clinical challenge. This study evaluated the clinical utility and cost-considerations of the multiplex polymerase chain reaction pneumonia panel (mPCR-PP) in a low-resource clinical setting.

Methodology: In this retrospective study, sputum or bronchoalveolar lavage (BAL) samples of 57 post-transplant adults with suspected lower respiratory tract infection were tested with mPCR-PP. The results were compared to standard cultures with the automated VITEK^® system. The impact of mPCR testing on modulating antibiotic therapy was recorded. Cost implications of antibiotic changes were also estimated.

Results: A total of 33 (57.9%) patients with liver, 23 (40.4%) patients with renal, and 1 (1.8%) patient with hematopoietic stem cell transplantation were included. The sensitivity and specificity of multiplex PCR were 75% and 53.3%, respectively. The positive predictive value was 72% and the negative predictive value was 57%. Multi-pathogen detection was noted in 17 (43.6%) cases with mPCR and 6 (15.4%) cases with cultures. A total of 75 bacterial pathogens were identified: Klebsiella pneumoniae (n = 19; 25.3%), Escherichia coli (n = 13; 17.3%), and Pseudomonas aeruginosa (n = 11; 14.6%). Resistance markers including CTX-M, NDM, and OXA-48-like were identified through mPCR. Antibiotic regimens of 15 (26.3%) patients were subsequently modified leading to 11.1% reduction in antibiotic prescriptions. Cost assessment for patients undergoing meropenem de-escalation (n = 8) revealed that up to $232 USD could have been saved per patient with early mPCR implementation.

Conclusions: Multiplex PCR boosts pathogen detection and provides cost benefits which support its potential integration into management of post-transplant pneumonia.