scholarly journals Multicenter Evaluation of the BioFire FilmArray Pneumonia/Pneumonia Plus Panel for Detection and Quantification of Agents of Lower Respiratory Tract Infection

2020 ◽  
Vol 58 (7) ◽  
Author(s):  
Caitlin N. Murphy ◽  
Randal Fowler ◽  
Joan Miquel Balada-Llasat ◽  
Amanda Carroll ◽  
Hanna Stone ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antimicrobial Stewardship ◽  
Lower Respiratory Tract ◽  
Diagnostic Testing ◽  
Molecular Methods ◽  
Marker Genes ◽  
Molecular Testing ◽  
Sample Treatment ◽  
Low Sensitivity ◽  
Tract Infections

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.

Diagnostic and antimicrobial stewardship with molecular respiratory testing across the SHEA Research Network

2020 ◽  
pp. 1-4
Author(s):  
Kimberly C. Claeys ◽  
Daniel J. Morgan ◽  
Surbhi Leekha ◽  
Kaede V. Sullivan
Keyword(s):  
Respiratory Tract ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Real World ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Research Network ◽  
Lower Respiratory Tract Infections ◽  
Panel Testing ◽  
Tract Infections

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.

scholarly journals Multicentre evaluation of two multiplex PCR platforms for the rapid microbiological investigation of nosocomial pneumonia in UK ICUs: the INHALE WP1 study

Thorax ◽  
2022 ◽  
pp. thoraxjnl-2021-216990
Author(s):  
Virve I Enne ◽  
Alp Aydin ◽  
Rossella Baldan ◽  
Dewi R Owen ◽  
Hollian Richardson ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Latent Class ◽  
Antimicrobial Treatment ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Microbiological Investigation ◽  
Increased Sensitivity ◽  
Low Sensitivity ◽  
Tract Infections

BackgroundCulture-based microbiological investigation of hospital-acquired or ventilator-associated pneumonia (HAP or VAP) is insensitive, with aetiological agents often unidentified. This can lead to excess antimicrobial treatment of patients with susceptible pathogens, while those with resistant bacteria are treated inadequately for prolonged periods. Using PCR to seek pathogens and their resistance genes directly from clinical samples may improve therapy and stewardship.MethodsSurplus routine lower respiratory tract samples were collected from intensive care unit patients about to receive new or changed antibiotics for hospital-onset lower respiratory tract infections at 15 UK hospitals. Testing was performed using the BioFire FilmArray Pneumonia Panel (bioMérieux) and Unyvero Pneumonia Panel (Curetis). Concordance analysis compared machine and routine microbiology results, while Bayesian latent class (BLC) analysis estimated the sensitivity and specificity of each test, incorporating information from both PCR panels and routine microbiology.FindingsIn 652 eligible samples; PCR identified pathogens in considerably more samples compared with routine microbiology: 60.4% and 74.2% for Unyvero and FilmArray respectively vs 44.2% by routine microbiology. PCR tests also detected more pathogens per sample than routine microbiology. For common HAP/VAP pathogens, FilmArray had sensitivity of 91.7%–100.0% and specificity of 87.5%–99.5%; Unyvero had sensitivity of 50.0%–100.0%%, and specificity of 89.4%–99.0%. BLC analysis indicated that, compared with PCR, routine microbiology had low sensitivity, ranging from 27.0% to 69.4%.InterpretationConventional and BLC analysis demonstrated that both platforms performed similarly and were considerably more sensitive than routine microbiology, detecting potential pathogens in patient samples reported as culture negative. The increased sensitivity of detection realised by PCR offers potential for improved antimicrobial prescribing.

Serological and molecular methods in diagnosis of lower respiratory tract infections caused due to Chlamydia pneumoniae

2020 ◽  
Vol 18 (4) ◽  
pp. 296
Author(s):  
SusmithaKarunasree Perumalla ◽  
YB Ashwin ◽  
ValsanPhilip Verghese ◽  
Anna Simon ◽  
Indira Agarwal ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Chlamydia Pneumoniae ◽  
Molecular Methods ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

scholarly journals Procalcitonin Use in a Large Community Healthcare System

2020 ◽  
Vol 41 (S1) ◽  
pp. s360-s360
Author(s):  
Mandelin Cooper ◽  
Hayley Burgess ◽  
Jeffrey Cuthbert ◽  
Edward Joel Septimus ◽  
Heather Signorelli
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Respiratory Tract ◽  
Antimicrobial Stewardship ◽  
Older Patients ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Lower Respiratory Tract Infections ◽  
Days Of Therapy ◽  
Tract Infections

Background: Appropriate testing of blood procalcitonin (PCT) can potentially inform antibiotic de-escalation in patients with severe infections. When used along with observed clinical improvements, PCT testing can support antimicrobial stewardship. However, this testing must be used optimally to ensure that it is actionable, cost-effective, and provides patient benefit. Although this test is widely used, little is known about the appropriateness of this testing in select populations. Methods: In this retrospective review, we evaluated PCT monitoring patterns and appropriateness of use and relationship to antibiotic days of therapy in a system of community hospitals. We evaluated the use of PCT testing in patients with known confounders, namely pregnancy, chronic kidney disease, or neutropenia, which we classified as “inappropriate use” because these conditions can affect the interpretation of PCT results. We also evaluated the relationship between PCT testing and antibiotic days of therapy for patients with sepsis, pneumonia, or lower respiratory tract infections. Results: In a 1-year period, ∼206,302 PCT tests were performed at 146 facilities, an average of ∼1,413 per facility per year. Approximately 27.7% of these tests were given to patients who were pregnant or had a confounding comorbidity such as chronic kidney disease or neutropenia. Of these “inappropriate” tests, >90% were given to patients with chronic kidney disease. Older patients (aged 60–80 years, n = 93,021) were more likely to receive a PCT test while also having a confounding comorbidities; 24% of older patients with a PCT test also had chronic kidney disease. Of all patients with a PCT test and chronic kidney disease, ∼76% were also diagnosed with either sepsis, pneumonia, or lower respiratory tract infections. Conclusions: Confounding conditions can affect PCT levels independently of infection. Additionally, some clinicians use PCT tests as probes for other physiological maladies. This analysis demonstrated that there is opportunity for education about the appropriate use of this test, how to interpret results in the presence of confounding conditions, and how to transform PCT test results into actions that facilitate antimicrobial stewardship and better patient care.Funding: NoneDisclosures: None

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