D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care
Authors: Reyes Luis Felipe , Serrano-Mayorga Cristian C. , Zhang Zhongheng , Tsuji Isabela , De Pascale Gennaro , Prieto Valeria Enciso , Mer Mervyn , Sheehan Elyce , Nasa Prashant , Zangana Goran , Avanti Kostoula , Tabah Alexis , Shrestha Gentle Sunder , Bracht Hendrik , Fatoni Arie Zainul , Abidi Khalid , bin Sulaiman Helmi , Eshwara Vandana Kalwaje , De Bus Liesbet , Hayashi Yoshiro , Korkmaz Pervin , Ait Hssain Ali , Buetti Niccolò , Goh Qing Yuan , Kwizera Arthur , Koulenti Despoina , Nielsen Nathan D. , Povoa Pedro , Ranzani Otavio , Rello Jordi , Conway Morris Andrew ,   for the D-PRISM Investigators,   Steering Committee, Reyes Luis Felipe , Zhang Zhongheng , Mer Mervyn , Tabah Alexis , Kwizera Arthur , Koulenti Despoina , Nielsen Nathan D. , Povoa Pedro , Ranzani Otavio , Rello Jordi , Conway Morris Andrew ,   National/Regional Co-ordinators, Mphandi Wilson , Ceccato Adrian , Tabah Alexis , Jahan Ahsina , De Bus Liesbet , Tsuji Isabela , Zhang Zhongheng , Reyes Luis Felipe , Jibaja Manuel , Alsisi Adel , Roquilly Antoine , Bracht Hendrik , Arvaniti Kostoula , Sandoval Nancy , Eshwara Vandana Kalwaje , Zainul Arie , Zand Faird , De Pascale Gennaro , Hayashi Yoshiro , Viderman Dimitry , Sulaiman Helmi bin , Lagunes Leonel , Nasa Prashant , Zangana Goran , Abidi Khalid , Shrestha Gentle , Schouten Jeroen , Buowari Dabota , Hashmi Madiha , Luque Nestor , Nora David , Hssain Ali Ait , Kuzovlev Artem , Goh Qing Yuan , Mer Mervyn , Rello Jordi , Hanifa Rashan , Sjovall Fredrik , Buetti Niccollò , Yeh Tony , Korkmaz Pervin , Kwizera Arthur , Shaban Nesreen , Hamed Islam , Sheehan Elyce 
Published: November 2024

Abstract
Background
Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide.

Methods
The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study.

Results
A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5–7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training.

Conclusions
This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU.
Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine.

Graphical abstract