Safety and efficacy of antimicrobial optimization based on negative results from BioFire FilmArray Pneumonia panel and respiratory culture
Abstract
Abstract Background: The BioFire FilmArray Pneumonia (BFP) panel is a multiplexed nucleic acid test intended to detect respiratory pathogens from sputum or bronchoalveolar lavage (BAL) specimens. Efficacy and safety of de-escalation strategies in patients with negative BFP results remain unclear. Methods: This was a multicenter, retrospective analysis of patients with suspected pneumonia and negative BFP and respiratory cultures. Patients were stratified into two groups: those whose antibiotic therapy was discontinued or withheld within 48 hours of a negative BFP (ATDW group) and those whose antibiotic therapy was continued (ATC group). We evaluated composite primary outcome of in-hospital mortality and 30-day readmission due to pneumonia (PNA) or recurrent PNA during index admission and secondary safety outcomes. Results: Among 500 patients with negative BFP assay, a total of 185 patients were included in the final analysis (59 ATDW vs. 126 ATC). The ATDW group had significantly shorter total duration of antibiotic therapy (1 day vs 7 days, p < 0.001). The primary composite outcome was similar between ATDW and ATC groups (23.1% vs 35.3%, P = 0.15). Multivariate analysis identified ICU admission and/or intubation (OR 7.5, 95% CI 3.17–17.52, P < 0.001) as only independent predictor of the composite primary outcome. The ATDW group experienced fewer rates of acute kidney injury (AKI)(8% vs 37%, P = 0.004). Conclusion: Antimicrobial optimization based on negative results from…
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