Abstract
Simple SummaryHospital-acquired pneumonia (HAP) imposes public health threats because of its high morbidity and mortality rate. Accordingly, this study aimed to evaluate the diagnostic performance of the multiplexed BioFire FilmArray Pneumonia Panel plus (BFPP) for the rapid detection of various clinically relevant respiratory pathogens and genetic markers among 50 patients admitted with HAP to an intensive care unit (ICU) in a tertiary care hospital in Egypt. In comparison to standard culture methods, BFPP showed an overall sensitivity and specificity of 100% and 90%, respectively, with the identification of 11 viral targets (22%) among the tested specimens. The BFPP semi-quantitative analysis showed a concordance rate of 47.4% among positive culture specimens. For the examination of the antibiotic resistance genes, BFPP showed a positive percent agreement (PPA), a negative percent agreement (NPA) and an overall percent agreement (OPA), reaching 97%, 95%, and 95%, respectively, with standard antibiotic sensitivity testing. According to the obtained results, BFPP has the potential to enhance the rapid microbiological diagnosis of HAP cases, tailor appropriate antibiotic therapy, apply antimicrobial stewardship programs, and implement effective infection control measures.Hospital-acquired pneumonia (HAP) is a substantial public health issue that is associated with high mortality rates and is complicated by an arsenal of microbial etiologies, expressing multidrug-resistant phenotypes, rendering relatively limited therapeutic options. BioFire FilmArray Pneumonia Panel plus (BFPP) is a simple multiplexed PCR system that integrates sample preparation, nucleic acid extraction, amplification, and analysis of microbial etiology, with a turnaround time of about one hour. In comparison to standard culture methods, BFPP is simpler, easier to perform, and can simultaneously detect the most common pathogens involved in lower respiratory tract infections (34 targets). Accordingly, we evaluated the diagnostic performance of the multiplexed BFPP for the rapid detection of 27 clinically relevant respiratory pathogens and 7 genetic markers among 50 HAP cases admitted to the intensive care unit (ICU), who submitted mini-bronchoalveolar (mBAL) specimens. In comparison to standard culture methods, BFPP showed an overall sensitivity of 100% [95% CI; 90–100] and overall specificity of 90% [95% CI; 87.4–92.5] among all the tested bacterial targets. BFPP identified 11 viral targets (22%) among the tested specimens. The BFPP semi-quantitative analysis showed a concordance rate of 47.4% among positive culture specimens. For the investigation of the antibiotic resistance genes, BFPP showed a positive percent agreement (PPA), a negative percent agreement (NPA), and an overall percent agreement (OPA), reaching 97% [95% CI; 90–100], 95% [95% CI; 91.5–97], and 95% [95% CI; 93–97], respectively, with standard antibiotic sensitivity testing. In conclusion, BFPP has the potential to enhance the rapid microbiological diagnosis of HAP cases, and could aid in tailoring appropriate antibiotic therapies.
Highlights
Lower respiratory tract infections (LRTIs), mainly pneumonia cases, are one of the most reported fatal infections among intensive care unit (ICU) patients, and it is estimated that all-cause pneumonia mortality rates might reach 70% or more with the current COVID-19 pandemic [1]
A total of 50 mBAL specimens were obtained from 50 patients hospitalized in the ICU
A total of 52 bacterial targets were detected by BioFire FilmArray Pneumonia Panel plus (BFPP) alone, and were considered as false positives, while 2 Pseudomonas putida (BFPP off-panel) were detected by conventional culture alone
Summary
Lower respiratory tract infections (LRTIs), mainly pneumonia cases, are one of the most reported fatal infections among intensive care unit (ICU) patients, and it is estimated that all-cause pneumonia mortality rates might reach 70% or more with the current COVID-19 pandemic [1]. Despite recent progress in the management of such nosocomial infections, hospital-acquired pneumonia (HAP, occurs 48 h or more after hospital admission) and its subcategory—ventilator-associated pneumonia (VAP, occurs 48 h or more after endotracheal intubation)—are still associated with high mortality rates, reaching. In addition to the associated morbidity and high finical burden within hospital settings, the microbiological diagnosis of HAP/VAP remains challenging. The development of rapid molecular diagnostic tools, coupled with updated epidemiological profiles of respiratory pathogens, as well as their antimicrobial sensitivity patterns, will be urgently required among HAP patients
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