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D-PRISM: a global survey-based study to assess diagnostic and treatment approaches in pneumonia managed in intensive care

Reyes LF 1 , Serrano-Mayorga CC 1 , Zhang Z 2 , Tsuji I 3 , De Pascale G 4 , Prieto VE 5 Show all authors , Mer M 6 , Sheehan E 7 , Nasa P 8 , Zangana G 9 , Avanti K 10 , Tabah A 11 , Shrestha GS 12 , Bracht H 13 , Fatoni AZ 14 , Abidi K 15 , Bin Sulaiman H 16 , Eshwara VK 17 , De Bus L 18 , Hayashi Y 19 , Korkmaz P 20 , Ait Hssain A 21 , Buetti N 22 , Goh QY 23 , Kwizera A 24 , Koulenti D 25 , Nielsen ND 7 , Povoa P 26 , Ranzani O 27 , Rello J 28 , Conway Morris A 29 , D-PRISM Investigators

Affiliations 

  • 1 Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
  • 2 Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
  • 3 Hospital Israelita Albert Einstein, São Paulo, Brazil
  • 4 Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
  • 5 Clinica Universidad de La Sabana, Chia, Colombia
  • 6 Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • 7 Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, USA
  • 8 Critical Care Medicine NMC Specialty Hospital Dubai, Dubai, UAE
  • 9 Department of Acute and General Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
  • 10 Intensive Care Medicine, Papageorgiou Hospital, Thessaloníki, Greece
  • 11 Queensland University of Technology, Brisbane, QLD, Australia
  • 12 Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
  • 13 Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
  • 14 Department of Anesthesiology and Intensive Therapy, Saiful Anwar General Hospital - Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia
  • 15 Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
  • 16 Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 17 Department of Microbiology Kasturba Medical College, Manipal Manipal Academy of Higher Education, Manipal, Karnataka, India
  • 18 Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
  • 19 Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
  • 20 Pulmonary Disease Department, Ege University School of Medicine, Izmir, Turkey
  • 21 Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
  • 22 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland
  • 23 Division of Anaesthesiology and Perioperative Medicine, Department of Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore
  • 24 Department of Anaesthesia, Makerere University, Kampala, Uganda
  • 25 Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
  • 26 Faculdade de Ciências Médicas, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
  • 27 Barcelona Institute for Global Health, ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
  • 28 Vall d'Hebron Institute of Research, Barcelona, Spain
  • 29 Division of Perioperative, Acute, Critical Care and Emergency Medicine, Department of Medicine, University of Cambridge, Level 4, Addenbrooke's Hospital, Hills Road, Cambridge, UK. [email protected]
Crit Care, 2024 Nov 22;28(1):381.
PMID: 39578900 DOI: 10.1186/s13054-024-05180-y

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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