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Caméléna F, Poncin T, Dudoignon E, Salmona M, Le Goff J, Donay JL, Lafaurie M, Darmon M, Azoulay E, Plaud B, Mebazaa A, Dépret F, Jacquier H, Berçot B. Rapid identification of bacteria from respiratory samples of patients hospitalized in intensive care units, with FilmArray Pneumonia Panel Plus. Int J Infect Dis 2021; 108:568-573. [PMID: 34087488 DOI: 10.1016/j.ijid.2021.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the performance of FilmArray Pneumonia Panel Plus (FA-PP) for the detection of typical bacterial pathogens in respiratory samples from patients hospitalized in intensive care units (ICUs). METHODS FA-PP was implemented for clinical use in the microbiology laboratory in March 2020. A retrospective analysis on a consecutive cohort of adult patients hospitalized in ICUs between March 2020 and May 2020 was undertaken. The respiratory samples included sputum, blind bronchoalveolar lavage (BBAL) and protected specimen brush (PSB). Conventional culture and FA-PP were performed in parallel. RESULTS In total, 147 samples from 92 patients were analysed; 88% had coronavirus disease 2019 (COVID-19). At least one pathogen was detected in 46% (68/147) of samples by FA-PP and 39% (57/147) of samples by culture. The overall percentage agreement between FA-PP and culture results was 98% (93-100%). Bacteria with semi-quantitative FA-PP results ≥105 copies/mL for PSB samples, ≥106 copies/mL for BBAL samples and ≥107 copies/mL for sputum samples reached clinically significant thresholds for growth in 90%, 100% and 91% of cultures, respectively. FA-PP detected resistance markers, including mecA/C, blaCTX-M and blaVIM. The median turnaround time was significantly shorter for FA-PP than for culture. CONCLUSIONS FA-PP may constitute a faster approach to the diagnosis of bacterial pneumonia in patients hospitalized in ICUs.
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Affiliation(s)
- François Caméléna
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Thibaut Poncin
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Emmanuel Dudoignon
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Maud Salmona
- University of Paris, Inserm U976, Insight team, F-75010, Paris France; Department of Virology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Le Goff
- University of Paris, Inserm U976, Insight team, F-75010, Paris France; Department of Virology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Donay
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Disease, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1153, Centre of Epidemiology and Biostatistics, ECSTRA Team, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1153, Centre of Epidemiology and Biostatistics, ECSTRA Team, Paris, France
| | - Benoît Plaud
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - François Dépret
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Hervé Jacquier
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Béatrice Berçot
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France.
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Jacobs MR, Colson JD, Rhoads DD. Recent advances in rapid antimicrobial susceptibility testing systems. Expert Rev Mol Diagn 2021; 21:563-578. [PMID: 33926351 DOI: 10.1080/14737159.2021.1924679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Until recently antimicrobial susceptibility testing (AST) methods based on the demonstration of phenotypic susceptibility in 16-24 h remained largely unchanged. AREAS COVERED Advances in rapid phenotypic and molecular-based AST systems. EXPERT OPINION AST has changed over the past decade, with many rapid phenotypic and molecular methods developed to demonstrate phenotypic or genotypic resistance, or biochemical markers of resistance such as β-lactamases associated with carbapenem resistance. Most methods still require isolation of bacteria from specimens before both legacy and newer methods can be used. Bacterial identification by MALDI-TOF mass spectroscopy is now widely used and is often key to the interpretation of rapid AST results. Several PCR arrays are available to detect the most frequent pathogens associated with bloodstream infections and their major antimicrobial resistance genes. Many advances in whole-genome sequencing of bacteria and fungi isolated by culture as well as directly from clinical specimens have been made but are not yet widely available. High cost and limited throughput are the major obstacles to uptake of rapid methods, but targeted use, continued development and decreasing costs are expected to result in more extensive use of these increasingly useful methods.
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Affiliation(s)
- Michael R Jacobs
- Emeritus Professor of Pathology and Emeritus Medical Director, Clinical Microbiology, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan D Colson
- Microbiology Fellow, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel D Rhoads
- Section Head of Microbiology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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103
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The Genotype-to-Phenotype Dilemma: How Should Laboratories Approach Discordant Susceptibility Results? J Clin Microbiol 2021; 59:JCM.00138-20. [PMID: 33441396 DOI: 10.1128/jcm.00138-20] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Traditional culture-based methods for identification and antimicrobial susceptibility testing (AST) of bacteria take 2 to 3 days on average. Syndromic molecular diagnostic panels have revolutionized clinical microbiology laboratories as they can simultaneously identify an organism and detect some of the most significant antimicrobial resistance (AMR) genes directly from positive blood culture broth or from various specimen types (e.g., whole blood, cerebrospinal fluid, and respiratory specimens). The presence or absence of an AMR marker associated with a particular organism can be used to predict the phenotypic AST results to more rapidly guide therapy. Numerous studies have shown that genotypic susceptibility predictions by syndromic panels can improve patient outcomes. However, an important limitation of AMR marker detection to predict phenotype is the potential discrepancies that may arise upon performing phenotypic AST of the recovered organism in culture. The focus of this minireview is to address how clinical laboratories should interpret rapid molecular results from commercial platforms in relation to phenotypic AST. Stepwise approaches and solutions are provided to resolve discordant results between genotypic and phenotypic susceptibility results.
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104
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Maataoui N, Chemali L, Patrier J, Tran Dinh A, Le Fèvre L, Lortat-Jacob B, Marzouk M, d'Humières C, Rondinaud E, Ruppé E, Montravers P, Timsit JF, Armand-Lefèvre L. Impact of rapid multiplex PCR on management of antibiotic therapy in COVID-19-positive patients hospitalized in intensive care unit. Eur J Clin Microbiol Infect Dis 2021; 40:2227-2234. [PMID: 33733394 PMCID: PMC7968559 DOI: 10.1007/s10096-021-04213-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/25/2021] [Indexed: 12/27/2022]
Abstract
Because the diagnosis of co/superinfection in COVID-19 patients is challenging, empirical antibiotic therapy is frequently initiated until microbiological analysis results. We evaluated the performance and the impact of the BioFire® FilmArray® Pneumonia plus Panel on 112 respiratory samples from 67 COVID-19 ICU patients suspected of co/superinfections. Globally, the sensitivity and specificity of the test were 89.3% and 99.1%, respectively. Positive tests led to antibiotic initiation or adaptation in 15% of episodes and de-escalation in 4%. When negative, 28% of episodes remained antibiotic-free (14% no initiation, 14% withdrawal). Rapid multiplex PCRs can help to improve antibiotic stewardship by administering appropriate antibiotics earlier and avoiding unnecessary prescriptions.
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Affiliation(s)
- Naouale Maataoui
- Université de Paris, INSERM, IAME, F-75006, Paris, France. .,Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP Nord, Université de Paris, 46 rue Henri Huchard, 75877, Paris Cedex 18, France.
| | - Lotfi Chemali
- Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP Nord, Université de Paris, 46 rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Juliette Patrier
- Medical and Infectious Diseases ICU (MI2), Hôpital Bichat, AP-HP, F-75018, Paris, France
| | - Alexy Tran Dinh
- Department of Anesthesiology and Surgical Critical Care, Hôpital Bichat, AP-HP, F-75018, Paris, France.,Université de Paris, INSERM U 1148, F-75006, Paris, France
| | - Lucie Le Fèvre
- Medical and Infectious Diseases ICU (MI2), Hôpital Bichat, AP-HP, F-75018, Paris, France
| | - Brice Lortat-Jacob
- Department of Anesthesiology and Surgical Critical Care, Hôpital Bichat, AP-HP, F-75018, Paris, France
| | - Mehdi Marzouk
- Medical and Infectious Diseases ICU (MI2), Hôpital Bichat, AP-HP, F-75018, Paris, France
| | - Camille d'Humières
- Université de Paris, INSERM, IAME, F-75006, Paris, France.,Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP Nord, Université de Paris, 46 rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Emilie Rondinaud
- Université de Paris, INSERM, IAME, F-75006, Paris, France.,Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP Nord, Université de Paris, 46 rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Etienne Ruppé
- Université de Paris, INSERM, IAME, F-75006, Paris, France.,Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP Nord, Université de Paris, 46 rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Philippe Montravers
- Department of Anesthesiology and Surgical Critical Care, Hôpital Bichat, AP-HP, F-75018, Paris, France.,Université de Paris, INSERM U 1148, F-75006, Paris, France
| | - Jean-François Timsit
- Université de Paris, INSERM, IAME, F-75006, Paris, France.,Medical and Infectious Diseases ICU (MI2), Hôpital Bichat, AP-HP, F-75018, Paris, France
| | - Laurence Armand-Lefèvre
- Université de Paris, INSERM, IAME, F-75006, Paris, France.,Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP Nord, Université de Paris, 46 rue Henri Huchard, 75877, Paris Cedex 18, France
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105
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Dudoignon E, Caméléna F, Deniau B, Habay A, Coutrot M, Ressaire Q, Plaud B, Berçot B, Dépret F. Bacterial Pneumonia in COVID-19 Critically Ill Patients: A Case Series. Clin Infect Dis 2021; 72:905-906. [PMID: 32544219 PMCID: PMC7337703 DOI: 10.1093/cid/ciaa762] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emmanuel Dudoignon
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Assistance Publique-Hôpitaux de Paris Nord, Saint Louis and Lariboisière University Hospitals, Paris, France.,Inserm UMR-S942, Lariboisière Hospital and Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists (INI-CRCT) Network, Nancy, France.,Paris University, Paris, France
| | - François Caméléna
- Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris Nord, Paris, France.,University of Paris, Inserm 1137, Infection Antimicrobials Modelling Evolution (IAME), Paris, France
| | - Benjamin Deniau
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Assistance Publique-Hôpitaux de Paris Nord, Saint Louis and Lariboisière University Hospitals, Paris, France.,Inserm UMR-S942, Lariboisière Hospital and Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists (INI-CRCT) Network, Nancy, France.,Paris University, Paris, France
| | - Adrien Habay
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Assistance Publique-Hôpitaux de Paris Nord, Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Maxime Coutrot
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Assistance Publique-Hôpitaux de Paris Nord, Saint Louis and Lariboisière University Hospitals, Paris, France.,Paris University, Paris, France
| | - Quentin Ressaire
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Assistance Publique-Hôpitaux de Paris Nord, Saint Louis and Lariboisière University Hospitals, Paris, France.,Paris University, Paris, France
| | - Benoit Plaud
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Assistance Publique-Hôpitaux de Paris Nord, Saint Louis and Lariboisière University Hospitals, Paris, France.,Inserm UMR-S942, Lariboisière Hospital and Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists (INI-CRCT) Network, Nancy, France.,Paris University, Paris, France
| | - Béatrice Berçot
- Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris Nord, Paris, France.,University of Paris, Inserm 1137, Infection Antimicrobials Modelling Evolution (IAME), Paris, France
| | - François Dépret
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Assistance Publique-Hôpitaux de Paris Nord, Saint Louis and Lariboisière University Hospitals, Paris, France.,Inserm UMR-S942, Lariboisière Hospital and Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists (INI-CRCT) Network, Nancy, France.,Paris University, Paris, France
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106
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Multinational evaluation of the BioFire® FilmArray® Pneumonia plus Panel as compared to standard of care testing. Eur J Clin Microbiol Infect Dis 2021; 40:1609-1622. [PMID: 33655440 PMCID: PMC7924818 DOI: 10.1007/s10096-021-04195-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
This study compared standard of care testing (SOC) to BioFire® FilmArray® Pneumonia plus Panel (PNplus). PNplus detects 15 bacteria with semiquantitative log bin values, 7 antibiotic resistance markers, three atypical bacteria (AB), and eight viral classes directly from bronchoalveolar lavage-like specimens (BLS) and sputum-like specimens (SLS). Fifty-two laboratories from 13 European countries and Israel tested 1234 BLS and 1242 SLS with PNplus and SOC. Detection rates and number of pathogens/samples were compared for PNplus pathogens. PNplus bin values and SOC quantities were compared. Three thousand two hundred sixty-two bacteria in PNplus were detected by PNplus and/or SOC. SOC detected 57.1% compared to 95.8% for PNplus (p ≤ 0.0001). PNplus semiquantitative bin values were less than SOC, equal to SOC, or greater than SOC in 5.1%, 25.4%, and 69.6% of results, respectively. PNplus bin values were on average ≥ 1 log than SOC values (58.5% 1–2 logs; 11.0% 3–4 logs). PNplus identified 98.2% of MRSA and SOC 55.6%. SOC detected 73/103 AB (70.9%) and 134/631 viruses (21.2%). PNplus detected 93/103 AB (90.3%) and 618/631 viruses (97.9%) (p ≤ 0.0001). PNplus and SOC mean number of pathogens/samples were 1.99 and 1.44, respectively. All gram-negative resistance markers were detected. PNplus and SOC results were fully or partially concordant for 49.1% and 26.4% of specimens, respectively. PNplus was highly sensitive and detected more potential pneumonia pathogens than SOC. Semiquantification may assist in understanding pathogen significance. As PNplus generates results in approximately 1 h, PNplus has potential to direct antimicrobial therapy in near real time and improve antimicrobial stewardship and patient outcomes.
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107
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Gilbert DN, Leggett JE, Wang L, Ferdosian S, Gelfer GD, Johnston ML, Footer BW, Hendrickson KW, Park HS, White EE, Heffner J. Enhanced Detection of Community-Acquired Pneumonia Pathogens With the BioFire® Pneumonia FilmArray® Panel. Diagn Microbiol Infect Dis 2021; 99:115246. [PMID: 33253962 PMCID: PMC7566680 DOI: 10.1016/j.diagmicrobio.2020.115246] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/28/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- David N Gilbert
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon.
| | - James E Leggett
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Lian Wang
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Shirin Ferdosian
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Gita D Gelfer
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Michael L Johnston
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Brent W Footer
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Kathryn W Hendrickson
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Hiromichi S Park
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - Emma E White
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
| | - John Heffner
- Department of Medical Education, Providence Portland Medical Center, Portland, Oregon
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108
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Multicenter Evaluation of the Unyvero Platform for Testing Bronchoalveolar Lavage Fluid. J Clin Microbiol 2021; 59:JCM.02497-20. [PMID: 33328178 DOI: 10.1128/jcm.02497-20] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023] Open
Abstract
Bronchoalveolar lavage (BAL) culture is a standard, though time-consuming, approach for identifying microorganisms in patients with severe lower respiratory tract (LRT) infections. The sensitivity of BAL culture is relatively low, and prior antimicrobial therapy decreases the sensitivity further, leading to overuse of empirical antibiotics. The Unyvero LRT BAL Application (Curetis GmbH, Germany) is a multiplex molecular panel that detects 19 bacteria, 10 antibiotic resistance markers, and a fungus, Pneumocystis jirovecii, in BAL fluid in ∼4.5 h. Its performance was evaluated using 1,016 prospectively collected and 392 archived specimens from 11 clinical trial sites in the United States. Overall positive and negative percent agreements with culture results for identification of bacteria that grow in routine cultures were 93.4% and 98.3%, respectively, with additional potential pathogens identified by Unyvero in 21.7% of prospectively collected specimens. For detection of P. jirovecii, the positive percent agreement with standard testing was 87.5%. Antibiotic resistance marker results were compared to standard antibiotic susceptibility test results to determine positive predictive values (PPVs). PPVs ranged from 80 to 100%, based on the microorganism and specific resistance marker(s). The Unyvero LRT BAL Application provides accurate detection of common agents of bacterial pneumonia and of P. jirovecii The sensitivity and rapidity of this panel suggest significant clinical value for choosing appropriate antibiotics and for antibiotic stewardship.
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109
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Clinical performance of the GenMark Dx ePlex respiratory pathogen panels for upper and lower respiratory tract infections. J Clin Virol 2021; 135:104737. [PMID: 33497932 DOI: 10.1016/j.jcv.2021.104737] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/26/2020] [Accepted: 01/11/2021] [Indexed: 12/13/2022]
Abstract
The GenMark Dx ePlex Respiratory Pathogen Panel (RP) is a multiplexed nucleic acid test for the qualitative detection of common viral and a few bacterial causes of respiratory tract infections. The ePlex RP has received FDA clearance for nasopharyngeal swab (NPS) specimens collected in viral transport media. In this study, we evaluated the performance of the ePlex RP panel in comparison to the NxTAG Respiratory Pathogen Panel (NxTAG-RPP) from Luminex in use in our laboratory, not only for NPS but also for bronchoalveolar lavage specimens (BAL). We also evaluated the impact of implementing the ePlex RP on the test turn-around time (TAT). The newest panel from GenMark Dx, the ePlex Respiratory Pathogen Panel 2 (RP2), which added the SARS-CoV-2 target to the RP was also evaluated for NPS. Verification of the performance of the ePlex RP for both NPS and BAL showed 93.3 % and 84.9 % total agreement with the NxTAG-RPP respectively. An overall comparison of the TAT after implementing the ePlex RP as compared to the NxTAG-RPP assay showed an average decrease of almost seven-fold.
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110
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Furukawa D, Kim B, Jeng A. Real-life utilization of BioFire® Filmarray® pneumonia panel as an antibiotic stewardship tool. Infect Dis (Lond) 2020; 53:308-313. [DOI: 10.1080/23744235.2020.1866774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Daisuke Furukawa
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - Brian Kim
- Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA, USA
- Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Arthur Jeng
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA, USA
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111
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Covert K, Bashore E, Edds M, Lewis PO. Utility of the respiratory viral panel as an antimicrobial stewardship tool. J Clin Pharm Ther 2020; 46:277-285. [PMID: 33277930 DOI: 10.1111/jcpt.13326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The development of rapid diagnostics has revolutionized antimicrobial stewardship with efforts targeting earlier de-escalation or discontinuation of antibiotics. The respiratory viral panel (RVP) is one tool quickly able to detect common viral and bacterial pathogens using polymerase chain reaction technology. Utility may be further enhanced in conjunction with procalcitonin (PCT). However, the optimal use of the RVP to the clinical pharmacist in the treatment of community-acquired respiratory infections remains unclear. METHODS The purpose of this guide is to review the available literature regarding the impact of the RVP with and without procalcitonin on antimicrobial stewardship efforts and to provide guidance on how to use each of these tools. RESULTS AND DISCUSSION In total, 13 studies were included, 5 of which utilized PCT in conjunction with RVP and 8 of which did not use PCT. The majority of studies were retrospective in nature, and the most common outcomes evaluated were antibiotic days of therapy (DOT) and time to antibiotic discontinuation. WHAT IS NEW AND CONCLUSION After review, RVP alone has limited value to antimicrobial stewardship; however, when used in conjunction with procalcitonin, RVP has the potential to reduce antibiotic use and duration.
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Affiliation(s)
- Kelly Covert
- East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, TN, USA
| | - Elizabeth Bashore
- East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, TN, USA
| | - McKenzie Edds
- East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, TN, USA
| | - Paul O Lewis
- Johnson City Medical Center, Johnson City, TN, USA
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112
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Diagnostic and antimicrobial stewardship with molecular respiratory testing across the SHEA Research Network. Infect Control Hosp Epidemiol 2020; 42:1010-1013. [PMID: 33267918 DOI: 10.1017/ice.2020.1328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This survey investigated diagnostic and antimicrobial stewardship practices related to molecular respiratory panel testing in adults with lower respiratory tract infections at acute care hospitals. Most respondents reported use of rapid respiratory panels, but related stewardship practices were uncommon and the real-world impact of respiratory panels were difficult to quantify.
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Rand KH, Beal SG, Cherabuddi K, Couturier B, Lingenfelter B, Rindlisbacher C, Jones J, Houck HJ, Lessard KJ, Tremblay EE. Performance of a Semiquantitative Multiplex Bacterial and Viral PCR Panel Compared With Standard Microbiological Laboratory Results: 396 Patients Studied With the BioFire Pneumonia Panel. Open Forum Infect Dis 2020; 8:ofaa560. [PMID: 33447631 PMCID: PMC7793460 DOI: 10.1093/ofid/ofaa560] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Microbiologic results are critical to optimal management of patients with lower respiratory tract infection, but standard methods may take several days. The multiplex polymerase chain reaction BioFire Pneumonia (PN) panel detects 15 common bacterial species semiquantitatively as copy number/mL, 8 viral species, and 7 resistance genes in about an hour within the clinical laboratory. Methods We tested 396 unique endotracheal or bronchoalveolar lavage specimens with the BioFire Pneumonia panel and compared the bacterial detections to conventional gram stain and culture results. Results Of the 396 patients, 138 grew at least 1 bacterium that had a target on the PN panel, and 136/138 (98.6%) were detected by the panel. A total of 177 isolates were recovered in culture and the PN panel detected 174/177 (98.3%). A further 20% of patients had additional targets detected that were not found on standard culture (specificity 69%, positive predictive value 63%, and negative predictive value 98.9%). Copy number was strongly related to standard semiquantitative growth on plates reported by the laboratory (eg, 1+, 2+, 3+ growths) and was significantly higher in those specimens that grew a potential pathogen. Both higher copy number and bacterial detections found by the PN panel, but not found in culture, were strongly positively related to the level of white blood cells reported in the initial gram stain. Conclusions Higher copy number and bacterial detections by the PN panel are related to the host respiratory tract inflammatory response. If laboratories can achieve a rapid turnaround time, the PN panel should have a significant impact both on patient management and on antibiotic stewardship.
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Affiliation(s)
- Kenneth H Rand
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Stacy G Beal
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | | | | | | | | | - Jay Jones
- BioFire Diagnostics, Salt Lake City, Utah, USA
| | - Herbert J Houck
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Kylie J Lessard
- Department of Infection Prevention and Control, UF Health Shands Hospital, Gainesville, Florida, USA
| | - Elizabeth E Tremblay
- Department of Infection Prevention and Control, UF Health Shands Hospital, Gainesville, Florida, USA.,Florida State University College of Medicine, Tallahassee, Florida, USA
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114
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Kolenda C, Ranc AG, Boisset S, Caspar Y, Carricajo A, Souche A, Dauwalder O, Verhoeven PO, Vandenesch F, Laurent F. Assessment of Respiratory Bacterial Coinfections Among Severe Acute Respiratory Syndrome Coronavirus 2-Positive Patients Hospitalized in Intensive Care Units Using Conventional Culture and BioFire, FilmArray Pneumonia Panel Plus Assay. Open Forum Infect Dis 2020; 7:ofaa484. [PMID: 33204762 PMCID: PMC7654374 DOI: 10.1093/ofid/ofaa484] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
Background Approximately 15% of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) present with severe forms of the disease and require hospitalization in intensive care units, which has been associated with high mortality rates. The prevalence of bacterial infections in these patients is not well established, and more data are needed to guide empiric antibiotic therapy and improve patient outcomes. Methods In this prospective multicenter study, we assessed bacterial coinfections identified in culture from 99 French patients infected by SARS-Cov-2 and hospitalized in intensive care units. We concomitantly evaluated an innovative molecular diagnostic technology technique, the BioFire, FilmArray Pneumonia Panel plus (FA-pneumo) assay, to identify these coinfections at an early stage, and its concordance with conventional culture. Results We showed that a bacterial coinfection was detected in 15% of patients based on conventional culture. Staphylococcus aureus and Haemophilus influenzae were the most prevalent pathogens. The sensitivity of FA-pneumo compared with culture was 100%. In contrast, the specificity varied between 88.4% and 100% according to the pathogen, and our results highlighted that 60.5% of bacterial targets reported using this assay were not recovered by culture; 76.9% of discordant results corresponded to bacteria belonging to commensal oral flora and/or reported with ≤105 copies/mL bacterial nucleic acids. Conclusions Based on its excellent sensitivity, the FA-pneumo assay is useful to rule out bacterial coinfections in the context of severe SARS-CoV-2 infection and avoid the inappropriate prescription of antibiotics. However, positive tests should be interpreted carefully, taking into consideration deoxyribonucleic acid bacterial load and all clinical and biological signs.
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Affiliation(s)
- Camille Kolenda
- Département de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Anne-Gaëlle Ranc
- Département de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Boisset
- Laboratoire de Bactériologie, Institut de Biologie et de Pathologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Yvan Caspar
- Laboratoire de Bactériologie, Institut de Biologie et de Pathologie, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Anne Carricajo
- Laboratoire des Agents Infectieux et d'Hygiène, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Aubin Souche
- Département de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Olivier Dauwalder
- Département de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Paul O Verhoeven
- Laboratoire des Agents Infectieux et d'Hygiène, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
| | - François Vandenesch
- Département de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Département de Bactériologie, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
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115
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Wagner AP, Enne VI, Livermore DM, Craig JV, Turner DA. Review of health economic models exploring and evaluating treatment and management of hospital-acquired pneumonia and ventilator-associated pneumonia. J Hosp Infect 2020; 106:745-756. [PMID: 32971194 DOI: 10.1016/j.jhin.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) is pneumonia that occurs ≥48 h after hospital admission; it is the most common hospital-acquired infection contributing to death. Ventilator-associated pneumonia (VAP) arises ≥48-72 h after intubation. Opinions differ on whether VAP is a subset of HAP; the same pathogens predominate in both. Compared with VAP-free controls, patients developing VAP are twice as likely to die and have significantly longer stays in intensive care units. Guidelines recommend that microbiological cultures should guide antibiotic treatment, but these lack sensitivity and take 48-72 h to process, meaning that initial therapy must be empiric, generally with broad-spectrum agents. Given increasing pressure to improve both antibiotic stewardship and patient outcomes, the National Institute for Health and Care Excellence and the Infectious Diseases Society of America recommend research into rapid molecular diagnostic tests to identify causative organisms and their antibiotic resistances. Ideally, these would supersede culture, being quicker and more sensitive. In the UK, the INHALE research programme, funded by the National Institute for Health Research, is exploring rapid molecular diagnostics to inform treatment of HAP/VAP and, given resource implications, incorporates a health economic component. AIM To identify previous economic modelling of HAP/VAP costs to inform this component. METHODS Literature review of HAP/VAP studies with economic modelling identified from three databases. FINDINGS Twenty studies were identified. Only one study specifically evaluated strategies to improve diagnosis; the remaining 19 studies omitted this important aspect. CONCLUSION HAP/VAP modelling would be improved by better awareness of long-term outcomes and treatment complexity. To the authors' knowledge, no similar literature reviews of economic modelling for HAP/VAP have been published.
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Affiliation(s)
- A P Wagner
- Norwich Medical School, University of East Anglia, Norwich, UK; National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK.
| | - V I Enne
- University College London, London, UK
| | - D M Livermore
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J V Craig
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - D A Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
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116
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Crémet L, Gaborit B, Bouras M, Drumel T, Guillotin F, Poulain C, Persyn E, Lakhal K, Rozec B, Vibet MA, Roquilly A, Gibaud S. Evaluation of the FilmArray ® Pneumonia Plus Panel for Rapid Diagnosis of Hospital-Acquired Pneumonia in Intensive Care Unit Patients. Front Microbiol 2020; 11:2080. [PMID: 32983057 PMCID: PMC7477898 DOI: 10.3389/fmicb.2020.02080] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/07/2020] [Indexed: 12/19/2022] Open
Abstract
The FilmArray® Pneumonia plus Panel (FAPP) is a new multiplex molecular test for hospital-acquired pneumonia (HAP), which can rapidly detect 18 bacteria, 9 viruses, and 7 resistance genes. We aimed to compare the diagnosis performance of FAPP with conventional testing in 100 intensive care unit (ICU) patients who required mechanical ventilation, with clinically suspected HAP. A total of 237 samples [76 bronchoalveolar lavages (BALDS) and 82 endotracheal aspirates (ETADS) obtained at HAP diagnosis, and 79 ETA obtained during follow-up (ETATT)], were analyzed independently by routine microbiology testing and FAPP. 58 patients had paired BALDS and ETADS. The positivity thresholds of semi-quantified bacteria were 103–104 CFUs/mL or 104 copies/mL for BAL, and 105 CFUs/mL or copies/mL for ETA. Respiratory commensals (H. influenzae, S. aureus, E. coli, S. pneumoniae) were the most common pathogens. Discordant results for bacterial identification were observed in 33/76 (43.4%) BALDS and 36/82 (43.9%) ETADS, and in most cases, FAPP identified one supplemental bacteria (23/33 BALDS and 21/36 ETADS). An absence of growth, or polybacterial cultures, explained almost equally the majority of the non-detections in culture. No linear relationship was observed between bin and CFUs/mL variables. Concordant results between paired BALDS and ETADS were obtained in 46/58 (79.3%) patients with FAPP. One of the 17 resistance genes detected with FAPP (mecA/C and MREJ) was not confirmed by conventional testing. Overall, FAPP enhanced the positivity rate of diagnostic testing, with increased recognition of coinfections. Implementing this strategy may allow clinicians to make more timely and informed decisions.
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Affiliation(s)
- Lise Crémet
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France.,Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France
| | - Benjamin Gaborit
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service de Maladies Infectieuses et Tropicales et CIC 1413, CHU Nantes, Nantes, France
| | - Marwan Bouras
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Thomas Drumel
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | - Florian Guillotin
- Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Cécile Poulain
- Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Elise Persyn
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | - Karim Lakhal
- Service de Réanimation en Chirurgie Polyvalente, Pôle Anesthésie-Réanimation, Hôpital Nord Laennec, CHU Nantes, Nantes, France
| | - Bertrand Rozec
- Service de Réanimation en Chirurgie Cardio-Thoracique et Vasculaire, Pôle Anesthésie-Réanimation, Hôpital Nord Laennec, CHU Nantes, Nantes, France
| | - Marie-Anne Vibet
- Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Antoine Roquilly
- Laboratoire UPRES EA3826, IRS2 - Nantes Biotech, Université de Nantes, Nantes, France.,Service d'Anesthésie Réanimation Chirurgicale, Pôle Anesthésie-Réanimation, CHU Nantes, Nantes, France
| | - Sophie Gibaud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
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117
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Pickens C, Wunderink RG, Qi C, Mopuru H, Donnelly H, Powell K, Sims MD. A multiplex polymerase chain reaction assay for antibiotic stewardship in suspected pneumonia. Diagn Microbiol Infect Dis 2020; 98:115179. [PMID: 32927409 PMCID: PMC7428672 DOI: 10.1016/j.diagmicrobio.2020.115179] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
Background Multiplexed molecular rapid diagnostic tests (RDTs) may allow for rapid and accurate diagnosis of the microbial etiology of pneumonia. However, little data are available on multiplexed RDTs in pneumonia and their impact on clinical practice. Methods This retrospective study analyzed 659 hospitalized patients for microbiological diagnosis of suspected pneumonia. Results The overall sensitivity of the Unyvero LRT Panel was 85.7% (95% CI 82.3–88.7) and the overall specificity was 98.4% (95% CI 98.2–98.7) with a negative predictive value of 97.9% (95% CI 97.6–98.1). The LRT Panel result predicted no change in antibiotics in 12.4% of cases but antibiotic de-escalation in 65.9% (405/615) of patients, of whom 278/405 (69%) had unnecessary MRSA coverage and 259/405 (64%) had unnecessary P. aeruginosa coverage. Interpretation In hospitalized adults with suspected pneumonia, use of an RDT on respiratory samples can allow for early adjustment of initial antibiotics, most commonly de-escalation.
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Affiliation(s)
- Chiagozie Pickens
- Northwestern University Feinberg School of Medicine, Department of Medicine, Pulmonary and Critical Care Division, Chicago, IL.
| | - Richard G Wunderink
- Northwestern University Feinberg School of Medicine, Department of Medicine, Pulmonary and Critical Care Division, Chicago, IL
| | - Chao Qi
- Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, IL
| | - Haritha Mopuru
- Beaumont Hospital, Royal Oak, Section of Infectious Diseases and International Medicine, Royal Oak, MI
| | - Helen Donnelly
- Northwestern University Feinberg School of Medicine, Department of Medicine, Pulmonary and Critical Care Division, Chicago, IL
| | - Kimberly Powell
- Beaumont Hospital, Royal Oak, Section of Infectious Diseases and International Medicine, Royal Oak, MI
| | - Matthew D Sims
- Beaumont Hospital, Royal Oak, Section of Infectious Diseases and International Medicine, Royal Oak, MI; Oakland University William Beaumont School of Medicine, Department of Internal Medicine, Rochester, MI
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118
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Multicenter Evaluation of the BioFire FilmArray Pneumonia/Pneumonia Plus Panel for Detection and Quantification of Agents of Lower Respiratory Tract Infection. J Clin Microbiol 2020; 58:JCM.00128-20. [PMID: 32350043 PMCID: PMC7315029 DOI: 10.1128/jcm.00128-20] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/01/2020] [Indexed: 01/05/2023] Open
Abstract
The ability to provide timely identification of the causative agents of lower respiratory tract infections can promote better patient outcomes and support antimicrobial stewardship efforts. Current diagnostic testing options include culture, molecular testing, and antigen detection. These methods may require collection of various specimens, involve extensive sample treatment, and can suffer from low sensitivity and long turnaround times. This study assessed the performance of the BioFire FilmArray Pneumonia Panel (PN panel) and Pneumonia Plus Panel (PNplus panel), an FDA-cleared sample-to-answer assay that enables the detection of viruses, atypical bacteria, bacteria, and antimicrobial resistance marker genes from lower respiratory tract specimens (sputum and bronchoalveolar lavage [BAL] fluid). Semiquantitative results are also provided for the bacterial targets. This paper describes selected analytical and clinical studies that were conducted to evaluate performance of the panel for regulatory clearance. Prospectively collected respiratory specimens (846 BAL and 836 sputum specimens) evaluated with the PN panel were also tested by quantitative reference culture and molecular methods for comparison. The PN panel showed a sensitivity of 100% for 15/22 etiologic targets using BAL specimens and for 10/24 using sputum specimens. All other targets had sensitivities of ≥75% or were unable to be calculated due to low prevalence in the study population. Specificity for all targets was ≥87.2%, with many false-positive results compared to culture that were confirmed by alternative molecular methods. Appropriate adoption of this test could provide actionable diagnostic information that is anticipated to impact patient care and antimicrobial stewardship decisions.
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