Rapid syndromic PCR testing in patients with respiratory tract infections reduces time to results and improves microbial yield

Abstract

Lack of rapid and comprehensive microbiological diagnosis in patients with community acquired pneumonia (CAP) hampers appropriate antimicrobial therapy. This study evaluates the real-world performance of the BioFire FilmArray Pneumonia panel plus (FAP plus) and explores the feasibility of evaluation in a randomised controlled trial. Patients presenting to hospital with suspected CAP were recruited in a prospective feasibility study. An induced sputum or an endotracheal aspirate was obtained from all participants. The FAP plus turnaround time (TAT) and microbiological yield were compared with standard diagnostic methods (SDs). 96/104 (92%) enrolled patients had a respiratory tract infection (RTI); 72 CAP and 24 other RTIs. Median TAT was shorter for the FAP plus, compared with in-house PCR (2.6 vs 24.1 h, p < 0.001) and sputum cultures (2.6 vs 57.5 h, p < 0.001). The total microbiological yield by the FAP plus was higher compared to SDs (91% (162/179) vs 55% (99/179), p < 0.0001). Haemophilus influenzae, Streptococcus pneumoniae and influenza A virus were the most frequent pathogens. In conclusion, molecular panel testing in adults with CAP was associated with a significant reduction in time to actionable results and increased microbiological yield. The impact on antibiotic use and patient outcome should be assessed in randomised controlled trials.

Performance of PCR‐based syndromic testing compared to bacterial culture in patients with suspected pneumonia applying microscopy for quality assessment

“…This finding indicates that indiscriminate use of BF could pose a risk of overdiagnosis and overuse of antibiotics and agrees with the concerns of Cohen et al ., thus underlining the importance of diagnostic stewardship [31]. Several studies have reported a potential for improved antimicrobial prescribing [32–34]. However, since the impact on patient outcome ( e.g ., length of stay, time on ventilator support, and use of antimicrobials) by BF have so far not been investigated by randomized, prospective outcome studies, the cost‐effectiveness of a more expensive rapid syndromic molecular panel test compared to culture for diagnosing pneumonia is unknown and should be considered before implementation as routine diagnostics.…”

“…However, since the impact on patient outcome ( e.g ., length of stay, time on ventilator support, and use of antimicrobials) by BF have so far not been investigated by randomized, prospective outcome studies, the cost‐effectiveness of a more expensive rapid syndromic molecular panel test compared to culture for diagnosing pneumonia is unknown and should be considered before implementation as routine diagnostics. As suggested by Serigstad et al , future randomized prospective outcome studies are needed to address this issue [34].…”

Impact of rapid molecular testing on diagnosis, treatment and management of community-acquired pneumonia in Norway: a pragmatic randomised controlled trial (CAPNOR)

“…To inform the trial, a prospective cohort feasibility study was carried out with 104 patients with suspected CAP [ 19 ]. The feasibility study mirrored the procedures described in the full-scale trial but without randomised of respiratory samples into two treatment arms.…”

“…Thus, the feasibility study informed on any procedural or design refinements that were needed for the ensuing full-scale trial. Results from the feasibility study are reported elsewhere [ 19 ].…”

Establishment and Clinical Application of a RPA-LFS Assay for Detection of Capsulated and Non-Capsulated Haemophilus influenzae

“…With the rapid development of molecular diagnostic technologies, PCR is widely used for the detection of various microorganisms ( Takahashi et al., 2021 ; Boukharouba et al., 2022 ; Serigstad et al., 2022 ). A PCR method was developed for the detection of H. influenzae based on the 16S rRNA gene.…”