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Background <p>Accurate microbiological documentation seems central for managing severe pneumonia. While the FilmArray<sup>®</sup> Pneumonia + panel (FA-PP) offers rapid pathogen identification, its effectiveness during antibiotic treatment and in predicting clinical outcomes remains unclear.</p> Methods <p>We conducted a prospective observational study across four ICUs from April 2022 to June 2024, including patients with ventilator-associated pneumonia (VAP) or ventilated hospital-acquired pneumonia (vHAP). Bacterial loads were monitored on days 0, 1, 3, 7 and 10 and 3 days after stopping antibiotics, using endotracheal aspirates (ETAs) analyzed by FA-PP and standard cultures. The main objective was to assess the correlation between quantitative changes in FA-PP results and clinical success. Quantitative changes over time were analyzed using mixed ordinal logistic regression.</p> Results <p>Of the 93 patients enrolled, 60.2% (<i>n</i> = 56) achieved clinical success, while the ICU mortality rate was 25.8% (<i>n</i> = 24). Although FA-PP and culture quantification results declined over time (<i>p</i> &lt; 0.0001), neither method consistently correlated with clinical success (non-significant for both). At diagnosis, FA-PP showed excellent diagnostic performance compared to culture, with a sensitivity of 94% [95% CI: 87–97] and a specificity of 98% [95% CI: 97–98]. Quantitative concordance improved with higher DNA copies, from 22.9% at the culture threshold at 10⁴ DNA copies/ml in FA-PP to 100% at ≥ 10⁷ DNA copies/ml. Diagnostic performance remained stable during antibiotic treatment with 94% sensitivity and 95% specificity in follow-up ETAs.</p> Conclusions <p>FA-PP provides rapid and accurate diagnostics, but repeated testing did not predict clinical outcomes during treatment, however our small sample size limited the study power.</p>

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Assessing FilmArray Pneumonia+ panel dynamics during antibiotic treatment to predict clinical success in ICU patients with ventilated hospital-acquired pneumonia and ventilator-associated pneumonia: a multicenter prospective study

  • 期刊论文

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  • 发表日期：

    2025年7月12日

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  • Julien Dessajan,
  • Michaël Thy,
  • Marc Doman,
  • Jules Stern,
  • Antoine Gallet,
  • Gaëlle Fouque,
  • Samuel Chosidow,
  • Stéphane Ruckly,
  • Signara Gueye,
  • Fariza Lamara,
  • Mariem Dlela,
  • Hermann Do Rego,
  • Michaël Ejzenberg,
  • Luc Haudebourg,
  • Julien Le Marec,
  • Cyril Potier,
  • Valentine Berti,
  • Nathalie Grall,
  • Stéphane Lo,
  • Naouale Maataoui,
  • Emilie Rondinaud,
  • Etienne Ruppé,
  • Frédéric Bert,
  • Véronique Leflon-Guibout,
  • Lila Bouadma,
  • Romain Sonneville,
  • Etienne de Montmollin,
  • Laurence Armand-Lefèvre,
  • Jean-François Timsit

摘要

Background

Accurate microbiological documentation seems central for managing severe pneumonia. While the FilmArray® Pneumonia + panel (FA-PP) offers rapid pathogen identification, its effectiveness during antibiotic treatment and in predicting clinical outcomes remains unclear.

Methods

We conducted a prospective observational study across four ICUs from April 2022 to June 2024, including patients with ventilator-associated pneumonia (VAP) or ventilated hospital-acquired pneumonia (vHAP). Bacterial loads were monitored on days 0, 1, 3, 7 and 10 and 3 days after stopping antibiotics, using endotracheal aspirates (ETAs) analyzed by FA-PP and standard cultures. The main objective was to assess the correlation between quantitative changes in FA-PP results and clinical success. Quantitative changes over time were analyzed using mixed ordinal logistic regression.

Results

Of the 93 patients enrolled, 60.2% (n = 56) achieved clinical success, while the ICU mortality rate was 25.8% (n = 24). Although FA-PP and culture quantification results declined over time (p < 0.0001), neither method consistently correlated with clinical success (non-significant for both). At diagnosis, FA-PP showed excellent diagnostic performance compared to culture, with a sensitivity of 94% [95% CI: 87–97] and a specificity of 98% [95% CI: 97–98]. Quantitative concordance improved with higher DNA copies, from 22.9% at the culture threshold at 10⁴ DNA copies/ml in FA-PP to 100% at ≥ 10⁷ DNA copies/ml. Diagnostic performance remained stable during antibiotic treatment with 94% sensitivity and 95% specificity in follow-up ETAs.

Conclusions

FA-PP provides rapid and accurate diagnostics, but repeated testing did not predict clinical outcomes during treatment, however our small sample size limited the study power.