Seba Hasan, MD,
Critical Care Fellow
University of Missouri Kansas City
Kansas City, MO
Disclosure information not submitted.
Nick Bennett, PharmD
Pharmacist
Saint Luke's Health System, United States
Disclosure information not submitted.
Majdi Hamarshi, MD
Intensivist
Saint Luke's Health System
Kansas City, Missouri, United States
Disclosure information not submitted.
Title: Assessing the Role of the BioFire Pneumonia PCR Panel in Antimicrobial Stewardship in the ICU
Introduction:
Timely identification of a culprit pathogen in pneumonia can reduce unwarranted antimicrobial use. The processing time for a final culture is 2-3 days, during which empirical broad-spectrum antibiotics are given. There are two commercially available PCR panels that provide results within hours. The latest is the BioFire Pneumonia Panel (PN Panel), which is a multiplex PCR assay that provides results in 75 minutes. The PN Panel detects 33 bacterial and viral pathogens, including antimicrobial resistance genes, from bronchioalveolar lavage (BAL) specimens. The other panel is the BioFire Respiratory 2 Panel (RP2 Panel), which is a PCR panel that detects 21 viral and bacterial pathogens. In this study we compared the impact of these two panels obtained from BAL respiratory culture on clinical decision making regarding antimicrobial therapy.
Methods:
This was a retrospective review of critically ill patients with suspected pneumonia who underwent BAL for respiratory culture and PCR testing between March 2019-February 2020 (RP2 Panel) and March 2020-February 2021 (PN Panel). Antimicrobial therapy modifications based off the PN Panel were compared to those with the RP2 Panel. We also assessed concordance rates of the PN Panel with culture results.
Results:
There were 61 patients in the PN Panel group and 70 in the RP2 group. The PN Panel led to a change in empiric antimicrobial regimens in 33% of the patients (escalation in 10%, de-escalation in 23%) compared to 4% in the RP2 group (P < 0.0001). However, there was no significant difference in total days of antibiotics between the two groups (8.7 vs 8.6, P=0.94). In 3% of the patients, the PN Panel detected pathogens that were not recovered by culture and led to escalation of antibiotics. The concordance rate between the PN panel and culture was 64%. Of the discordant results, 54.5% were due to PN panel positive and culture negative scenarios. The PN Panel detected resistance that was not detected by culture in 4.5% of the patients and missed resistance that was recovered by culture in 9% of the patients.
Conclusion:
The PN Panel when compared to RP 2 panel has significantly led to a change in the empiric antibiotics regimen in critically ill patients.