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.

Blake W Buchan,Nathan A Ledeboer,Matthew L Faron,Jennifer Dien Bard,Amanda Harrington,Oluseun Akerele,Derya Mahmutoglu,Sukantha Chandrasekaran,Andrew Bonwit,Amy Leber,Sam Windham,Holly Huse,Amanda Carroll,Angela Huang,Shelley Campeau,Christina Kwong,Corrin Graue,Kathy Everhart,Amanda Hopp,Shira Ronen,Romney M Humphries ,Samia N Naccache ,Caitlin N Murphy ,Randal C Fowler ,Rebecca J Buckner ,Ryan F Relich ,Joan Miquel Balada-Llasat ,Hannah K Stone ,Del A Warren

doi:10.1128/jcm.00135-20

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.

Highlights

Citation Buchan BW, Windham S, Balada-Llasat J-M, Leber A, Harrington A, Relich R, Murphy C, Dien Bard J, Naccache S, Ronen S, Hopp A, Mahmutoglu D, Faron ML, Ledeboer NA, Carroll A, Stone H, Akerele O, Everhart K, Bonwit A, Kwong C, Buckner R, Warren D, Fowler R, Chandrasekaran S, Huse H, Campeau S, Humphries R, Graue C, Huang A. 2020
The PN panel reports qualitative (“detected” or “not detected”) results for viral targets, bacterial targets associated with atypical pneumonia, and antibiotic resistance markers while providing a semiquantitative value for 15 additional bacterial targets commonly associated with respiratory infections (Table 1)
Specimens were selected from adult inpatients, since this population is at highest risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) and frequently receives broad-spectrum empirical antibiotic therapy for presumptive respiratory tract infections, including those caused by multidrug-resistant pathogens

Summary

Introduction

Citation Buchan BW, Windham S, Balada-Llasat J-M, Leber A, Harrington A, Relich R, Murphy C, Dien Bard J, Naccache S, Ronen S, Hopp A, Mahmutoglu D, Faron ML, Ledeboer NA, Carroll A, Stone H, Akerele O, Everhart K, Bonwit A, Kwong C, Buckner R, Warren D, Fowler R, Chandrasekaran S, Huse H, Campeau S, Humphries R, Graue C, Huang A. 2020. Quantitative and qualitative bacterial culture has been the primary approach for laboratory diagnosis of lower respiratory tract infections, including pneumonia These methods are useful in establishing definitive antibiotic therapy; recovery of potential pathogens is variable due to antibiotic exposure prior to specimen collection, fastidious growth characteristics of some pathogens, or overgrowth of resident flora [9]. Molecular diagnostics, including PCR-based tests, generate a sensitive result within hours of specimen collection These tests have the potential to reduce the duration of broad-spectrum empirical antibiotic therapy by identifying pathogenic organisms or specific antibiotic resistance markers 2 to 3 days sooner than routine methods. This is consistent with current culture-based laboratory protocols for Journal of Clinical Microbiology jcm.asm.org 2

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