rapid solution for diagnosis of respiratory infection in pediatric intensive care unit

Conditions: Severe Infections Pneumonia With Invasive Ventilation in PICU

Summary: in patients with infectious pneumonitis, the filmarray® pneumonia plus panel technique (multiplex pcr) on a respiratory sample makes it possible to identify the responsible pathogen and its resistance to antibiotics in less than an hour and therefore to quickly adapt the anti- infectious. filmarray® pneumonia plus has been validated on two types of specimens from adult intubated patients, tracheal aspirations and bronchoalveolar lavage. it has not been validated on protected distal samples which are nevertheless used in current practice. this project will study the diagnostic validity of this technique performed on this type of sample. if the validity is demonstrated, this will allow this technique to be used on the protected distal sample which is a reliable sample and used in the context of respiratory infections, in particular acquired under ventilation in children (bronchoalveolar lavage is less easy and little used in practice in children).

in patients with infectious pneumonitis, the filmarray® pneumonia plus panel technique (multiplex pcr) on a respiratory sample makes it possible to identify the responsible pathogen and its resistance to antibiotics in less than an hour and therefore to quickly adapt the anti- infectious. filmarray® pneumonia plus has been validated on two types of specimens from adult intubated patients, tracheal aspirations and bronchoalveolar lavage. it has not been validated on protected distal samples which are nevertheless used in current practice. this project will study the diagnostic validity of this technique performed on this type of sample. if the validity is demonstrated, this will allow this technique to be used on the protected distal sample which is a reliable sample and used in the context of respiratory infections, in particular acquired under ventilation in children (bronchoalveolar lavage is less easy and little used in practice in children). as a result, this will allow a faster etiological diagnosis and adapted antibiotic therapy, guaranteeing better efficacy and a fairer antibiotic prescription. currently no studies concerning the filmarray® pneumonia plus panel are ongoing or have been performed with the protected distal samples. this study would be innovative and unique in looking at its feasibility and validity on a type of sample used in current practice. in addition, the use of a pcr-based technique allows a rapid microbiological diagnosis of lower respiratory infections under invasive mechanical ventilation, compared to the reference technique requiring 48 to 72 hours to give a definitive result. this much shorter period allows for an appropriate antibiotic therapy early in the treatment, and potentially a reduction in ventilation and hospitalization times. in addition, it detects antibiotic resistance genes allowing rapid identification of multi-resistant bacteria (resistant staphylococcus aureus meticillin, enterobacteria producing esbls or carbapenemases) and thus adapting antibiotic therapy. our study will assess its diagnostic validity for the identification of the microorganisms responsible for pneumonia in intensive care and their resistance to antibiotics.

Eligibility criteria:
inclusion criteria: * patients hospitalized in pediatric intensive care * patients under mechanical ventilation (intubated or tracheostomized) * age \<18 years old exclusion criteria: * contraindications to protected distal sampling * refusal to participate by at least one parent or legal guardian(s) * patient not covered by health insurance

Keywords: pneumonia pediatrics multiplex pcr mechanical ventilation