Background: The different PCR panels of BIOFIRE® FILMARRAY® have been individually studied with a focus on etiological diagnosis accuracy. Our study evaluates the clinical impact of using several BIOFIRE® FILMARRAY® panels for severe community acquired infections (CAI) as a part of an antimicrobial stewardship program run by a Clinical Microbiology Department.
Materials/methods: Prospective study in a 1200-bed tertiary hospital from October 2018 to September 2019. Patients with CAI requiring admission in which sepsis was suspected (blood cultures obtained) with additional samples available in the Laboratory, were included. Meningitis/Encephalitis, Respiratory and Gastrointestinal BIOFIRE® FILMARRAY® panels were performed in Cerebrospinal fluid (CSF), nasopharyngeal swabs (NPS) and feces respectively. Rapid results were informed to physicians in charge of each patient and antimicrobial adjustment was advised by a clinical microbiologist within the working shift. Conventional methods and BIOFIRE® FILMARRAY® panels were compared regarding diagnostic yield and turnaround time (TAT). Antimicrobial adjustment within 24 hours after rapid results was recorded.
Results: During the study period, 146 samples from 142 patients were included. Filmarray panels were applied to the following samples: 46 fecal samples, 51 NPS and 49 CSF. Overall, 119/142 patients (83.5%) were clinically diagnosed with an infection. Of them, 102 were diagnosed with an infection covered by the three panels: respiratory infection in 50, gastrointestinal infection in 25 and central nervous system infection in 27. Seventeen cases had infection of other location and the remaining 23 were finally diagnosed with a non-infectious process. Of the 102 patients with an infection covered by the panels, an etiological diagnosis was obtained in 64 (62.7%): 54 (52.9%) by BIOFIRE® FILMARRAY® panels and 25 (24.5%) by conventional methods (both yielded positive results in 13, 12.7%). Mean TAT was 2.4 hours for BIOFIRE® FILMARRAY® vs 94 hours for conventional methods. Antimicrobial adjustment within 24 hours of rapid results was made in 64/142 patients (45%): de-escalation in 50 (35.2%), escalation in 14 (19.8%).
Conclusions: BIOFIRE® FILMARRAY® panels provide higher diagnostic performance than conventional methods in a TAT as short as 2 hours. A high impact on antimicrobial stewardship was observed, leading to an early adjustment of empirical treatment in almost half of the patients.