Enhanced Detection of Community-Acquired Pneumonia Pathogens With the BioFire® Pneumonia FilmArray® Panel

Abstract

Background Although most observational studies identify viral or bacterial pathogens in 50% or less of patients hospitalized with community-acquired pneumonia (CAP), we previously demonstrated that a multi-test bundle (MTB) detected a potential pathogen in 73% of patients. This study compares detection rates for potential pathogens with the MTB versus the Biofire ® Pneumonia FilmArray ® panel (BPFA) multiplex PCR platform and presents an approach for integrating BPFA results as a foundation for subsequent antibiotic stewardship (AS) activities. Methods Between January 2017 to March 2018, all patients admitted for CAP were enrolled. Patients were considered evaluable if all elements of the MTB and the BPFA were completed, and they met other a priori inclusion criteria. The primary endpoint was the percentage of potential pathogens detected using the MTB (8 viral and 6 bacterial targets) versus the BPFA (8 viral and 18 bacterial targets). Blood and sputum cultures were performed on all patients. Two or more procalcitonin (PCT) levels assisted clinical assessments as to whether detected bacteria were invading or colonizing. Results Of 585 enrolled patients, 274 were evaluable. A potential viral pathogen was detected in 40.5% with MTB versus 60.9% of patients with BPFA with an odds ratio (95% CI) of 9.00 (4.12 to 23.30) p<0.01. A potential bacterial pathogen was identified in 66.4% with the MTB vs 75.5% with the BPFA odds ratio (95% CI) of 2.09 (1.24 to 3.59), p 0.003). Low PCT levels helped identify detected bacteria as colonizers.

Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study

“…In our study, baseline PCT levels were positively associated with the daily ordinal scale and PSI, confirming PCT as a predictive biomarker of COVID-19 severity in hospitalized patients. PCT levels correlated with microbial outcomes but given the use of significant amounts of antimicrobials, the possibility that overgrowth of normal flora resulting in skewed microbiologic identification exists [ 53 ].…”

Correlation between the Antibiotic Resistance Genes and Susceptibility to Antibiotics among the Carbapenem-Resistant Gram-Negative Pathogens

“…Patients suffering from community-acquired pneumonia usually receive empirical antimicrobial therapy, while the guidelines reserve microbiological testing for severe cases [ 55 ]. Standard microbiological identification techniques, followed by antimicrobial susceptibility testing, and then followed by PCR identification of the resistance genes of concern is a tedious process that requires several days.…”

“…It is extremely important to implement rapid techniques that allow the identification of the causative pathogens within a few hours. This would ensure more effective antimicrobial therapy within a few hours following the diagnosis [ 55 ]. One of these techniques is the Biofire ® FilmArray ® Pneumonia Panel which accurately identifies 33 targets in sputum and bronchoalveolar lavage samples in about one hour.…”

Identification of bacterial co-detections in COVID-19 critically Ill patients by BioFire® FilmArray® pneumonia panel: a systematic review and meta-analysis

“…While the improved diagnostic yield of BioFire PN/PN plus among COVID-19 patients is recent in the literature, many studies have reflected this broadly among pneumonia patients. A recent study evaluating the diagnostic yield of the panel versus a pneumonia multi-test bundle determined the panel was twice as likely to yield determination of the bacterial etiology for community-acquired pneumonia (CAP) while costing $60 less per case for testing [Gilbert et al, 2020] . Moreover, in a multinational evaluation among 52 laboratories, the BioFire PN plus was associated with a 20% increase in detections of one of more pathogens per specimen compared to standard of care testing [Ginocchio et al, 2020] .…”