Case 1: Use to improve AMS (Pneumonia)

In this video, Professor Bassetti presents a patient case study in which syndromic testing was used to add value to diagnosis, treatment and outcome.

Case summary

• Patient admitted with hospital-acquired pneumonia (HAP) from the previous hospital stay for pancreatitis the week before
• Patient showing classical signs of pneumonia
• Patient septic so antibiotic therapy required immediately. Key risks/considerations included:
  • Risk of gram-negative (Pseudomonas, Klebsiella, and other Enterobacterales) infection, as well as Staphylococcus aureus, due to previous hospitalisation
  • Risk of viral origin, or even typical microbes of community-acquired pneumonia (CAP) as the patient also spent time out of hospital
• Patient prescribed piperacillin/tazobactam (pip/taz) alone
• Syndromic test performed on bronchoalveolar lavage (BAL)

Case resolution

A few hours after the syndromic test was performed on the patient’s BAL sample, results showed that the causative agent was Streptococcus pneumoniae (seen in CAP). Pip/taz was therefore de-escalated, and the patient’s antibiotic therapy was changed to ceftriaxone (2 g/day).

This is a classic example of how syndromic testing can be used safely to optimise antimicrobial stewardship.