Practical Comparison of the BioFire FilmArray Pneumonia Panel to Routine Diagnostic Methods and Potential Impact on Antimicrobial Stewardship in Adult Hospitalized Patients with Lower Respiratory Tract Infections

Abstract

Lower respiratory tract infections, including hospital-acquired and ventilator-associated pneumonia, are common in hospitalized patient populations. Standard methods frequently fail to identify the infectious etiology due to the polymicrobial nature of respiratory specimens and the necessity of ordering specific tests to identify viral agents. The potential severity of these infections combined with a failure to clearly identify the causative pathogen results in administration of empirical antibiotic agents based on clinical presentation and other risk factors. We examined the impact of the multiplexed, semiquantitative BioFire FilmArray Pneumonia panel (PN panel) test on laboratory reporting for 259 adult inpatients submitting bronchoalveolar lavage (BAL) specimens for laboratory analysis. The PN panel demonstrated a combined 96.2% positive percent agreement (PPA) and 98.1% negative percent agreement (NPA) for the qualitative identification of 15 bacterial targets compared to routine bacterial culture. Semiquantitative values reported by the PN panel were frequently higher than values reported by culture, resulting in semiquantitative agreement (within the same log10 value) of 43.6% between the PN panel and culture; however, all bacterial targets reported as >105 CFU/ml in culture were reported as ≥105 genomic copies/ml by the PN panel. Viral targets were identified by the PN panel in 17.7% of specimens tested, of which 39.1% were detected in conjunction with a bacterial target. A review of patient medical records, including clinically prescribed antibiotics, revealed the potential for antibiotic adjustment in 70.7% of patients based on the PN panel result, including discontinuation or de-escalation in 48.2% of patients, resulting in an average savings of 6.2 antibiotic days/patient.

A multiplex polymerase chain reaction assay for antibiotic stewardship in suspected pneumonia

“…A recent study of the BioFire FilmArray Pneumonia panel concluded that the panel could also allow antibiotic adjustment in 71% of cases including discontinuation or de-escalation in 48% of patients. ( Buchan et al, 2020 ) These findings, particularly the utility of a rapid diagnostic test for antibiotic de-escalation, were similar to the findings in our study of the LRT Panel. The two panels have important differences.…”

Evaluation of the FilmArray® Pneumonia Plus Panel for Rapid Diagnosis of Hospital-Acquired Pneumonia in Intensive Care Unit Patients

“…As expected, implementation of FAPP shortened the delay in getting results (4 h 15 min on average, one ICU setting being located 10 km away from the laboratory vs. 64-70 h with culture). In accordance with recent evaluations (Lee et al, 2019;Buchan et al, 2020;Murphy et al, 2020;Yoo et al, 2020), FAPP increased the positivity rate of diagnostic testing (81.6% for BAL DS , and 75.6% for ETA DS ), enabling identification of additional bacteria in 39.5% BAL DS and 37.8% ETA DS . The most common pathogens detected were consistently the same across both methods (i.e., in order of prevalence, H. influenzae, S. aureus, E. coli, S. pneumoniae, and K. pneumoniae).…”

“…However, in the same manner as for H. influenzae, discrepant results obtained for S. aureus in 7 patients (FAPP-positive but culture-negative), were not always explained by no bacterial growth. As noted previously, these findings pointed the limits of bacterial cultures, which are subject to interpretation and based on selection of dominant species assigned to play a pathogenic role, the minority species being not considered (Buchan et al, 2020;Murphy et al, 2020). These results confirmed the need to inoculate selective agars for enhancing detection of specific bacteria in lower airways (Chapin and Doern, 1983;Doern and Brogden-Torres, 1992).…”

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

“…In representative studies, the BPFA panel detected a viral and/or bacterial potential pathogen in 47.4 to 72% of the CAP patients ( Lee et al, 2019 , Murphy et al, 2020 , Webber et al, 2020 , Buchan et al, 2020 ). The number of patients varied from 595 to 1682.…”