Performance evaluation of a PCR panel (FilmArray® Pneumonia Plus) for detection of respiratory bacterial pathogens in respiratory specimens: A systematic review and meta-analysis

Moy, Anne-Clotilde; Kimmoun, Antoine; Merkling, Thomas; Berçot, Béatrice; Caméléna, François; Poncin, Thibaut; Deniau, Benjamin; Mebazaa, Alexandre; Dudoignon, Emmanuel; Dépret, François; Gastli, Nabil; Cattoir, Vincent; Maataoui, Naouale; Armand-Lefèvre, Laurence; Mitton, Barend; Hoover, Jonathan; Greenland, John R.; Posteraro, Brunella; Sanguinetti, Maurizio; Kyriazopoulou, Evdoxia; Giamarellos-Bourboulis, Evangelos J.; Menchinelli, Giulia; Joannard, Brune

doi:10.1016/j.accpm.2023.101300

Cited by 15 publications

(4 citation statements)

References 56 publications

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“…A very recent review article by Moy et al performed a meta-analysis on the diagnostic performances of FA-PNEU for the detection of respiratory bacterial pathogens in 8968 respiratory specimens. They concluded that 9.3% of bacteria detected in a culture were not included in the panel [21]. Similarly, these tests detect broad-spectrum resistance genes that clearly do not cover all currently encountered beta-lactamases.…”

Section: Discussionmentioning

confidence: 99%

Optimized Antibiotic Management of Critically Ill Patients with Severe Pneumonia Following Multiplex Polymerase Chain Reaction Testing: A Prospective Clinical Exploratory Trial

Verroken,

Favresse,

Anantharajah

et al. 2024

Antibiotics

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Molecular diagnostic testing is assumed to enable fast respiratory pathogen identification and contribute to improved pneumonia management. We set up a prospective clinical trial at a tertiary hospital intensive care unit including adult patients suspected of severe pneumonia from whom a lower respiratory tract sample could be obtained. During control periods (CPs), routine testing was performed, and during intervention periods (IPs), this testing was completed with the FilmArray Pneumonia Panel plus test (FA-PNEU) executed 24/7. The main objective was to measure the impact of FA-PNEU results in terms of reduced time to targeted antimicrobial treatment administration. Over a 10-month period, analysis was performed on 35 CP and 50 IP patients. The median time to targeted antimicrobial treatment administration was reduced to 4.3 h in IPs compared to 26.4 h in CPs, with 54% of IP patients having FA-PNEU results that led to a treatment modification, of which all but one were targeted. Modifications included 10 (37%) de-escalations, 7 (25.9%) escalations, 3 (11.1%) regimen switches, and 7 (25.9%) complete antimicrobial discontinuations. FA-PNEU results were available with a 42.3 h gain compared to routine identification. This prospective study confirmed retrospective data demonstrating the benefit of FA-PNEU testing in severe pneumonia management of critically ill patients through improved antimicrobial use.

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Section: Discussionmentioning

confidence: 99%

Optimized Antibiotic Management of Critically Ill Patients with Severe Pneumonia Following Multiplex Polymerase Chain Reaction Testing: A Prospective Clinical Exploratory Trial

Verroken,

Favresse,

Anantharajah

et al. 2024

Antibiotics

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“…For viruses, the PPA has also done well (96.7%) as compared to monoplex PCR [11]. A recent meta-analysis including 30 observational studies and 8969 samples also revealed high diagnostic performance for the FilmArray Pneumonia+ Panel as compared to a standard culture [12]. The authors pointed out the lower diagnostic performance of mPCR for sputum, due to frequent contamination by oropharyngeal flora, leading to numerous false positive results.…”

Section: Viral and Bacterial Detectionmentioning

confidence: 99%

Impact of Multiplex PCR in the Therapeutic Management of Severe Bacterial Pneumonia

Dessajan,

Timsit

2024

Antibiotics

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Pneumonia is a common and severe illness that requires prompt and effective management. Advanced, rapid, and accurate tools are needed to diagnose patients with severe bacterial pneumonia, and to rapidly select appropriate antimicrobial therapy, which must be initiated within the first few hours of care. Two multiplex molecular tests, Unyvero HPN and FilmArray Pneumonia+ Panel, have been developed using the multiplex polymerase chain reaction (mPCR) technique to rapidly identify pathogens and their main antibiotic resistance mechanisms from patient respiratory specimens. Performance evaluation of these tests showed strong correlations with reference techniques. However, good knowledge of their indications, targets, and limitations is essential. Collaboration with microbiologists is, therefore, crucial for their appropriate use. Under these conditions, and with standardized management, these rapid tests can improve the therapeutic management of severe pneumonia faster, more precisely, and with narrow-spectrum antibiotic therapy. Further randomized controlled trials are needed to address the many unanswered questions about multiplex rapid molecular testing during the diagnosis and the management of severe pneumonia. This narrative review will address the current knowledge, advantages, and disadvantages of these tests, and propose solutions for their routine use.

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“…This trend extends to pneumonia, where molecular platforms now offer sample-to-answer highly multiplexed PCR (mPCR) for comprehensive viral and bacterial etiologies, as well as antimicrobial resistance (AMR) markers and semi-quantitative assessments. The developing role of molecular testing in pneumonia diagnostics has been highlighted in recent literature establishing increased sensitivity and faster time to results compared to culture-based methods [3]. Despite the technical superiority of molecular testing, debates continue regarding the role of molecular testing in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

Walker,

Timbrook,

Hommel

et al. 2024

Diagnostics

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The advent of rapid molecular microbiology testing has revolutionized infectious disease diagnostics and is now impacting pneumonia diagnosis and management. Molecular platforms offer highly multiplexed assays for diverse viral and bacterial detection, alongside antimicrobial resistance markers, providing the potential to significantly shape patient care. Despite the superiority in sensitivity and speed, debates continue regarding the clinical role of multiplex molecular testing, notably in comparison to standard methods and distinguishing colonization from infection. Recent guidelines endorse molecular pneumonia panels for enhanced sensitivity and rapidity, but implementation requires addressing methodological differences and ensuring clinical relevance. Diagnostic stewardship should be leveraged to optimize pneumonia testing, emphasizing pre- and post-analytical strategies. Collaboration between clinical microbiologists and bedside providers is essential in developing implementation strategies to maximize the clinical utility of multiplex molecular diagnostics in pneumonia. This narrative review explores these multifaceted issues, examining the current evidence on the clinical performance of multiplex molecular assays in pneumonia, and reflects on lessons learned from previous microbiological advances. Additionally, given the complexity of pneumonia and the sensitivity of molecular diagnostics, diagnostic stewardship is discussed within the context of current literature, including implementation strategies that consider pre-analytical and post-analytical modifications to optimize the clinical utility of advanced technologies like multiplex PCR.

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Performance evaluation of a PCR panel (FilmArray® Pneumonia Plus) for detection of respiratory bacterial pathogens in respiratory specimens: A systematic review and meta-analysis

Cited by 15 publications

References 56 publications

Optimized Antibiotic Management of Critically Ill Patients with Severe Pneumonia Following Multiplex Polymerase Chain Reaction Testing: A Prospective Clinical Exploratory Trial

Optimized Antibiotic Management of Critically Ill Patients with Severe Pneumonia Following Multiplex Polymerase Chain Reaction Testing: A Prospective Clinical Exploratory Trial

Impact of Multiplex PCR in the Therapeutic Management of Severe Bacterial Pneumonia

Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

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