Clinical impact of a multiplex rapid diagnostic pneumonia panel in critically ill patients

Abstract

Objective: To evaluate the clinical impact of the BioFire FilmArray Pneumonia Panel (PNA panel) in critically ill patients. Design: Single-center, preintervention and postintervention retrospective cohort study. Setting: Tertiary-care academic medical center. Patients: Adult ICU patients. Methods: Patients with quantitative bacterial cultures obtained by bronchoalveolar lavage or tracheal aspirate either before (January–March 2021, preintervention period) or after (January–March 2022, postintervention period) implementation of the PNA panel were randomly screened until 25 patients per study month (75 in each cohort) who met the study criteria were included. Antibiotic use from the day of culture collection through day 5 was compared. Results: The primary outcome of median time to first antibiotic change based on microbiologic data was 50 hours before the intervention versus 21 hours after the intervention (P = .0006). Also, 56 postintervention regimens (75%) were eligible for change based on PNA panel results; actual change occurred in 30 regimens (54%). Median antibiotic days of therapy (DOTs) were 8 before the intervention versus 6 after the intervention (P = .07). For the patients with antibiotic changes made based on PNA panel results, the median time to first antibiotic change was 10 hours. For patients who were initially on inadequate therapy, time to adequate therapy was 67 hours before the intervention versus 37 hours after the intervention (P = .27). Conclusions: The PNA panel was associated with decreased time to first antibiotic change and fewer antibiotic DOTs. Its impact may have been larger if a higher percentage of potential antibiotic changes had been implemented. The PNA panel is a promising tool to enhance antibiotic stewardship.

Implementation of a Rapid Multiplex Polymerase Chain Reaction Pneumonia Panel and Subsequent Antibiotic De-escalation

“…A recently published study described implementation of this PNP in ICU patients after a 2-month educational rollout including educational sessions and written communication to ICU providers and pharmacists; its findings demonstrated that the implementation of this tool may shorten both the time to first antibiotic change based on microbiologic data and the time to adequate therapy [ 18 ]. This further demonstrated the impact that intensive education can have on provider-driven antimicrobial changes in response to a new tool.…”

“…Several study groups have performed theoretical analyses comparing hypothetical PNP-directed antimicrobial use with traditional culture-driven antimicrobial use and have identified numerous potential opportunities for changes to antimicrobial prescribing [ 3–5 , 8–11 ]. However, there are limited data on actual antimicrobial changes made in response to PNP results [ 12–17 ] and very little data comparing clinical antimicrobial changes informed by PNP with those informed by conventional microbiologic methods [ 18 ]. Therefore, we initiated a pilot study aiming to evaluate antibiotic de-escalation immediately following implementation of the PNP in critically ill patients treated for pneumonia at our institution before widespread education on the tool and compare this with antibiotic de-escalation practices before PNP.…”