Evaluation of the FilmArray ® Pneumonia Plus Panel for Rapid Diagnosis of Hospital-Acquired Pneumonia in Intensive Care Unit Patients.

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 (BAL _DS ) and 82 endotracheal aspirates (ETA _DS ) obtained at HAP diagnosis, and 79 ETA obtained during follow-up (ETA _TT )], were analyzed independently by routine microbiology testing and FAPP. 58 patients had paired BAL _DS and ETA _DS . The positivity thresholds of semi-quantified bacteria were 10 ³ -10 ⁴ CFUs/mL or 10 ⁴ copies/mL for BAL, and 10 ⁵ 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%) BAL _DS and 36/82 (43.9%) ETA _DS , and in most cases, FAPP identified one supplemental bacteria (23/33 BAL _DS and 21/36 ETA _DS ). 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 BAL _DS and ETA _DS 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.
(Copyright © 2020 Crémet, Gaborit, Bouras, Drumel, Guillotin, Poulain, Persyn, Lakhal, Rozec, Vibet, Roquilly and Gibaud.)