Background: The etiological diagnosis of bacterial pneumonia is based on the identification of causal pathogens by cultures, which require prolonged incubation periods and have limited sensitivity. The BIOFIRE® Pneumonia plus Panel enables rapid and accurate automated testing for 27 bacteria and viruses that cause pneumonia directly from patient samples and can improve diagnostic accuracy to guide antibiotic treatments. In this study, we hypothesize that improved detection of pathogens by BIOFIRE® Pneumonia plus Panel can improve culture-based diagnosis and cause changes for therapeutic management.
Materials/methods: From April 2019 – Nov 2019 we enrolled 20 adult patients admitted to the Medical ICU with acute respiratory failure within 24 h of intubation for mechanical ventilation. We performed BIOFIRE® Pneumonia plus Panel to determine pathogen identification in lower respiratory tract samples, and assessed individualized antimicrobial stewardship.
Results: 20/22 patients could perform culture. 14/20 patients (60%) presented significative bacterial count cultures. BIOFIRE® Pneumonia plus Panel detected a pathogen in 20% of the culture-negative patients, and most of them had being exposed to broad-spectrum empiric therapy. When BIOFIRE® Pneumonia plus Panel reported > 107 copies / ml, concordance with a significative count (>106) was 85%. BIOFIRE® Pneumonia plus Panel had an overall 59% impact on the antibiotic adequation. For patients without treatment or with incorrect treatment, BIOFIRE® Pneumonia plus Panel result always guided a change in therapy. For BIOFIRE® Pneumonia plus Panel negative samples, change/de-escalation in antimicrobial treatment were made only in 49% of the cases. On the other hand, in patients with adequate broad-spectrum empirical treatment, the BIOFIRE® Pneumonia plus Panel results were followed only in 43% of cases.
Conclusions: BIOFIRE® Pneumonia plus Panel allows a faster and enhanced detection of pathogenic bacteria; BIOFIRE® Pneumonia plus Panel offers a substantial opportunity for individualized therapeutic targeting and antimicrobial stewardship in ICU patients with mechanical ventilation pneumonia.