Dataset Information

Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings.

ABSTRACT:

Objective

The BioFire FilmArray Respiratory Panel (RFA) has been proposed as a tool that can aid in the timely diagnosis and treatment of respiratory tract infections but its effect on antibiotic prescribing among adult patients has varied. We evaluated the impact of RFA result on antibiotic days of therapy (DOTs) in 2 distinct cohorts: hospitalized patients and patients discharged from the emergency department (ED).

Design

Retrospective cohort study.

Setting

The study was conducted in 3 community hospitals in Des Moines, Iowa, from March 3 to March 16, 2019.

Patients

Adults aged >18 years.

Methods

Potential outcome means and average treatment effects for RFA results on antibiotic DOTs were estimated. Inverse probability of treatment weighting with regression adjustment was used.

Results

We identified 243 patients each in the hospitalized and ED-discharged cohorts. Among hospitalized patients, RFA results did not affect antibiotic DOTs. Among patients discharged from the ED, we found that if all patients had had influenza detected, the average DOTs would have been 2.3 DOTs (-3.2 to -1.4) less than the average observed if all the patients had had a negative RFA (P < .0001); no differences in DOTs were observed when comparing an RFA with a noninfluenza virus detected compared to an RFA with negative results.

Conclusions

The impact of RFA results on antibiotic DOTs varies by clinical setting, and reductions were observed only among patients discharged from the ED who had influenza A or B detected.

SUBMITTER: Manatrey-Lancaster JJ

PROVIDER: S-EPMC9495546 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings.

Manatrey-Lancaster Jenna J JJ Bushman Amanda M AM Caligiuri Meagan E ME Rosa Rossana R

Antimicrobial stewardship & healthcare epidemiology : ASHE 20210624 1

<h4>Objective</h4>The BioFire FilmArray Respiratory Panel (RFA) has been proposed as a tool that can aid in the timely diagnosis and treatment of respiratory tract infections but its effect on antibiotic prescribing among adult patients has varied. We evaluated the impact of RFA result on antibiotic days of therapy (DOTs) in 2 distinct cohorts: hospitalized patients and patients discharged from the emergency department (ED).<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>The study was ...[more]

PMID: 36168499

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Project description:BackgroundExisting panels for lower respiratory tract infections (LRTIs) are slow and lack quantification of important pathogens and antimicrobial resistance, which are not solely responsible for their complex etiology and antibiotic resistance. BioFire FilmArray Pneumonia (PN) panels may provide rapid information on their etiology.MethodsThe bronchoalveolar lavage fluid of 187 patients with LRTIs was simultaneously analyzed using a PN panel and cultivation, and the impact of the PN panel on clinical practice was assessed. The primary endpoint was to compare the consistency between the PN panel and conventional microbiology in terms of etiology and drug resistance, as well as to explore the clinical significance of the PN panel. The secondary endpoint was pathogen detection using the PN panel in patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).ResultsFifty-seven patients with HAP and 130 with CAP were included. The most common pathogens of HAP were Acinetobacter baumannii and Klebsiella pneumoniae, with the most prevalent antimicrobial resistance (AMR) genes being CTX-M and KPC. For CAP, the most common pathogens were Haemophilus influenzae and Staphylococcus aureus, with the most frequent AMR genes being CTX-M and VIM. Compared with routine bacterial culture, the PN panel demonstrated an 85% combined positive percent agreement (PPA) and 92% negative percent agreement (NPA) for the qualitative identification of 13 bacterial targets. PN detection of bacteria with higher levels of semi-quantitative bacteria was associated with more positive bacterial cultures. Positive concordance between phenotypic resistance and the presence of corresponding AMR determinants was 85%, with 90% positive agreement between CTX-M-type extended-spectrum beta-lactamase gene type and phenotype and 100% agreement for mecA/C and MREJ. The clinical benefit of the PN panel increased by 25.97% compared with traditional cultural tests.ConclusionThe bacterial pathogens and AMR identified by the PN panel were in good agreement with conventional cultivation, and the clinical benefit of the PN panel increased by 25.97% compared with traditional detection. Therefore, the PN panel is recommended for patients with CAP or HAP who require prompt pathogen diagnosis and resistance identification.

Project description:Introduction. Immediate identification of travellers' diarrhoea-causing pathogens may not be possible in remote settings, but samples can be stored for epidemiological and related research. We collected pilot data to evaluate the utility of three different preservation media for testing stored faecal samples compared to immediate testing of fresh samples using the BioFire® FilmArray® multiplex PCR gastrointestinal panel (bioMérieux).Gap statement. No previous studies have demonstrated the utility of testing faecal samples directly by PCR BioFire® FilmArray® following prolonged storage and transportation in OMNIgene®, DNA™ shield and FTA™ cards.Aims. To evaluate the reliability of OMNIgene®, DNA shield™ and FTA™ card faecal storage and transport media in parallel, compared to initial testing of fresh faeces obtained from the same individuals at the time of presentation with diarrhoea in the field compare the results of faecal samples stored and transported at ambient temperature in OMNIgene®, DNA shield™ and FTA™ cards then tested using PCR BioFire® FilmArray® 6-18 months later with those obtained from fresh faecal samples during a diarrhoea outbreak.Methodology. Fresh faecal samples were obtained from British military personnel who developed diarrhoea during deployment to Kenya between February-April 2022. Unpreserved fresh samples were tested onsite using PCR BioFire® FilmArray® and corresponding samples were stored at ambient temperature in OMNIgene®200 (DNAgenotek®), DNA/RNA shield DX™ (Zymo Research) and Whatman FTA™ Elute cards (GE Healthcare) then repatriated to the UK for direct testing by PCR BioFire® FilmArray®, 6-18 months later. The most common enteropathogens evaluated were: Cryptosporidium spp., Enteroaggregative Escherichia coli (E. coli; EAEC), Enteropathogenic E. coli (EPEC), Shiga toxin-producing E. coli (STEC) and Campylobacter spp. Test results for the three storage modalities were compared to the fresh sample tests as a reference standard.Results. Samples from 60 individuals [80% male; median (interquartile range) age 24 (22-28) years] were analysed. Test sensitivity for Campylobacter spp. and EAEC was high across all three storage modalities (86.4-100%). OMNIgene®200 and DNA/RNA shield™ showed significant concordance with the reference standard test for other pathogens, but FTA™ Elute card tests had low sensitivity for STEC and poor specificity for Campylobacter spp. Agreement between FTA™ Elute cards and the reference standard test was low-moderate (kappa coefficient ≤0-0.49) for all enteropathogens.Conclusions. This study demonstrates successful PCR BioFire® FilmArray® utility in testing samples stored in different media and is the first to compare the use of OMNIgene®200, DNA/RNA shield™ and FTA™ Elute cards simultaneously with the results of clinical samples. Stored samples were tested up to 18 months later with significant concordance observed in OMNIgene®200 and DNA/RNA shield™ compared to reference standard testing. The distorted performance of FTA™ Elute card testing requires further optimisation. Testing of samples stored in these media is suitable for research studies, but their applicability with other molecular diagnostic platforms, or clinical diagnostics, requires confirmation.

Dataset Information

Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings.

Objective

Design

Setting

Patients

Methods

Results

Conclusions

Publications

Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings.

Similar Datasets

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