Background

Although most observational studies identify viral or bacterial pathogens in 50% or less of patients hospitalized with community-acquired pneumonia (CAP), we previously demonstrated that a multi-test bundle (MTB) detected a potential pathogen in 73% of patients. This study compares detection rates for potential pathogens with the MTB versus the Biofire® Pneumonia FilmArray® panel (BPFA) multiplex PCR platform and presents an approach for integrating BPFA results as a foundation for subsequent antibiotic stewardship (AS) activities.

Methods

Between January 2017 to March 2018, all patients admitted for CAP were enrolled. Patients were considered evaluable if all elements of the MTB and the BPFA were completed, and they met other a priori inclusion criteria. The primary endpoint was the percentage of potential pathogens detected using the MTB (8 viral and 6 bacterial targets) versus the BPFA (8 viral and 18 bacterial targets). Blood and sputum cultures were performed on all patients. Two or more procalcitonin (PCT) levels assisted clinical assessments as to whether detected bacteria were invading or colonizing.

Results

Of 585 enrolled patients, 274 were evaluable. A potential viral pathogen was detected in 40.5% with MTB versus 60.9% of patients with BPFA with an odds ratio (95% CI) of 9.00 (4.12 to 23.30) p<0.01. A potential bacterial pathogen was identified in 66.4% with the MTB vs 75.5% with the BPFA odds ratio (95% CI) of 2.09 (1.24 to 3.59), p 0.003). Low PCT levels helped identify detected bacteria as colonizers.

中文翻译：

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使用 BioFire® Pneumonia FilmArray® Panel 增强对社区获得性肺炎病原体的检测

背景

尽管大多数观察性研究在 50% 或更少的社区获得性肺炎 (CAP) 住院患者中发现了病毒或细菌病原体，但我们之前已经证明，多重测试集束 (MTB) 在 73% 的患者中检测到了潜在的病原体。本研究比较了 MTB 与 Biofire ® Pneumonia FilmArray ® panel (BPFA) 多重 PCR 平台对潜在病原体的检出率，并提出了一种整合 BPFA 结果的方法，作为后续抗生素管理 (AS) 活动的基础。

方法

2017 年 1 月至 2018 年 3 月期间，所有因 CAP 入院的患者均入组。如果完成了 MTB 和 BPFA 的所有要素，并且满足其他先验纳入标准，则认为患者可评估。主要终点是使用 MTB（8 个病毒和 6 个细菌目标）与 BPFA（8 个病毒和 18 个细菌目标）检测到的潜在病原体的百分比。对所有患者进行血液和痰培养。两个或多个降钙素原 (PCT) 水平有助于临床评估检测到的细菌是入侵还是定植。

结果

在 585 名登记患者中，274 名可评估。在 40.5% 的 MTB 和 60.9% 的 BPFA 患者中检测到潜在的病毒病原体，优势比（95% CI）为 9.00（4.12 至 23.30）p<0.01。66.4% 的 MTB 与 75.5% 的 BPFA 比值比 (95% CI) 为 2.09（1.24 至 3.59），p = 0.003，发现了潜在的细菌病原体。低 PCT 水平有助于将检测到的细菌识别为定植者。