No Major Advantage Seen With mPCR and Procalcitonin Combo in ICU-Treated Pneumonia: MULTI-CAP Trial
France: A new study has found that using a combination of multiplex PCR (mPCR) testing and serum procalcitonin levels to guide antibiotic management in critically ill patients with community-acquired pneumonia (CAP) did not significantly reduce antibiotic exposure or improve outcomes when compared to standard care. The findings of the MULTI-CAP randomized controlled trial were published on July 15, 2025, in Intensive Care Medicine by Dr. Guillaume Voiriot of Sorbonne Université, Assistance Publique – Hôpitaux de Paris, and his research team.
The trial aimed to assess whether a management approach incorporating rapid, broad-spectrum mPCR testing alongside procalcitonin biomarker guidance could minimize unnecessary antibiotic use in the intensive care unit (ICU) without compromising patient safety.
Conducted across 20 centers, the study enrolled non-immunocompromised adults (aged 18 and above) who were admitted to the ICU with CAP. Participants were randomly assigned to two groups. The intervention group received both conventional microbiological tests and respiratory mPCR testing, with antibiotic decisions guided by an algorithm based on mPCR findings and procalcitonin levels. In contrast, the control group was managed using standard microbiological investigations alone. In both groups, clinicians considered stopping antibiotics beginning on Day 3 and reassessed daily up to Day 7 based on procalcitonin levels and their progression.
Between October 2018 and March 2022, a total of 406 patients were randomized. The final analysis included 385 patients. The analysis revealed the following findings:
- On Day 28, the median number of days patients were alive and free of antibiotics was 19 days in both the intervention and control groups.
- The primary outcome showed no statistically significant difference between the two groups.
- The intervention group had a shorter cumulative duration of antibiotic use by an average of three days compared to the control group.
- The incidence of serious adverse events was similar in both groups, indicating that the intervention did not increase patient harm.
- Despite the reduced antibiotic duration, the strategy did not lead to a meaningful improvement in antibiotic-free survival.
The researchers concluded that while the use of mPCR and procalcitonin-guided algorithms can slightly reduce the total duration of antibiotic exposure, this approach did not translate into better clinical outcomes or significant reductions in antibiotic use over the 28 days. These findings suggest that, although mPCR offers rapid pathogen identification, its integration with procalcitonin monitoring may not yet be sufficient to replace standard decision-making protocols in the ICU for patients with CAP.
The study highlights the need for further research to refine diagnostic and antibiotic stewardship strategies in critical care settings, balancing the benefits of rapid diagnostics with meaningful clinical improvements.
Reference:
Voiriot, G., Argaud, L., Cohen, Y. et al. Combined use of a multiplex PCR and serum procalcitonin to reduce antibiotic exposure in critically ill patients with community-acquired pneumonia: the MULTI-CAP randomized controlled trial. Intensive Care Med (2025). https://doi.org/10.1007/s00134-025-08014-9
