Rapid molecular diagnostics with FilmArray® Pneumonia Panel Plus in respiratory infections: comparison with traditional culture methods and impact on antibiotic resistance and healthcare-associated infections (HAI).
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Abstract
BACKGROUND AND AIM
The global rise in antibiotic resistance due to the presence of multidrug-resistant pathogens threatens the effectiveness of antibiotic treatment for community and hospital-acquired pneumonia in hospitals. Fast Microbiology plays a key role in providing rapid responses that can be integrated into stewardship processes aimed at initiating appropriate antibiotic therapy as quickly as possible, managing critically ill patients and preventing the spread of healthcare-associated infections. The aim of this study was to identify the frequency and number of the pathogens responsible for lower respiratory tract infections causing pneumonia and for the presence of the major antimicrobial resistance genes, obtained using Fast Microbiology techniques and confirmed by standard culture methods.
MATERIALS AND METHODS
This prospective observational study was conducted between May 2024 and May 2025 and involved a total of 223 hospitalized patients who had a lower respiratory tract sample collected via bronchoalveolar lavage (BAL) for a suspected clinical diagnosis of pneumonia. The group of patients included both patients who had acquired pneumonia in the community and patients that did not suffer from respiratory diseases at the time of admission, but who had developed a lower respiratory tract infection within 48 hours from admission or during hospitalization. To diagnose infection or colonization, the collected biological samples were analyzed using both the culture method, considered the gold standard, and a "Fast Microbiology" method: the FilmArray® Biofire Pneumonia Panel plus (PNplus panel).
RESULTS
In the group of patients analyzed (n = 223), the percentage of positive samples detected with the PNplus panel and the culture method was, respectively, 39% (86/223) and 2% (4/223) of cases. However, the total number of positive samples for both the PNplus panel and the culture method corresponded to 47% (104/223). The Pneumonia plus panel detected more bacterial agents than the culture method, with relatively high PPA (96%), NPA (97%) and 0.68 of Cohen’s kappa. This result suggests a substantial correlation between the expected and detected results collected using the "Fast" molecular method and culture one, the latter considered the gold standard.
CONCLUSIONS
Community-acquired and hospital-acquired pneumonia are a leading cause of mortality worldwide, especially in critically ill patients. We are facing a silent pandemic: infections caused by multidrug-resistant germs, many of which are responsible for HAIs, mainly related to pneumonia (the leading cause of death from infection in hospitalized patients), and against which most available antibiotics are ineffective. The use of FilmArray® Biofire Pneumonia Panel plus (PNplus panel) could improve the clinical outcome of critically ill patients with worsening pneumonia. Rapid diagnosis would help clinicians in selecting and starting an antibiotic therapy, meeting antimicrobial stewardship criteria and reducing the spread of healthcare-associated infections caused by multidrug-resistant pathogens.
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