Impact of FilmArray™ Respiratory Panel testing on the clinical management of pediatric bone marrow transplant
Mimi R Precit1,2, Kaidi He3, Kanokporn Mongkolrattanothai3,4
1Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Insights
The FilmArray™ Respiratory Panel (FA-RP) aids rapid diagnosis of viral respiratory infections in pediatric bone marrow transplant (BMT) patients, guiding treatment and infection control. Repeat testing often provided no new clinical information, highlighting the need for judicious use.
Area of Science:
- * Medical diagnostics
- * Virology
- * Hematology-oncology
Background:
- * Viral respiratory tract infections pose significant risks to bone marrow transplant (BMT) patients.
- * Rapid and sensitive diagnostic tools are crucial for managing these infections.
- * Limited data exists on the FilmArray™ Respiratory Panel (FA-RP) utility in pediatric BMT settings.
Purpose of the Study:
- * To investigate the use, results, and clinical impact of FA-RP testing in pediatric BMT patients.
- * To evaluate the clinical significance of FA-RP in guiding patient management.
- * To assess the impact of repeat FA-RP testing.
Main Methods:
- * Retrospective analysis of 671 respiratory specimens from 204 pediatric BMT patients (01/01/2016–01/01/2019).
- * Data abstracted included patient demographics, diagnoses, FA-RP results, testing indications, and symptoms.
- * Clinical management impacts on antimicrobial therapy, procedures, infection control, and BMT scheduling were reviewed.
Main Results:
- * 40% of specimens tested positive, with human rhinovirus/enterovirus being most common.
- * FA-RP provided rapid diagnosis in over 50% of symptomatic patients.
- * Testing informed antiviral initiation in a majority of influenza cases and guided antimicrobial management in 11 instances.
- * Repeat testing yielded no new clinical information in 70% of cases.
- * Negative FA-RP results cleared patients for BMT in 22 instances.
Conclusions:
- * FA-RP is valuable for rapid diagnosis and management of viral respiratory infections in pediatric BMT patients.
- * The test informs critical decisions regarding antiviral therapy, antimicrobial use, and infection control.
- * Judicious use of repeat FA-RP testing is recommended to avoid unnecessary resource utilization.
Abstract:
Viral respiratory tract infections cause significant morbidity in bone marrow transplant (BMT) patients. Speed and sensitivity of the FilmArray™ Respiratory Panel (FA-RP) can improve care but may prompt inappropriate testing. Studies describing FA-RP use in pediatric BMT patients are limited; we investigated FA-RP use, results, and clinical management to evaluate clinical significance of testing in pediatric BMT patients. Retrospective analysis of 671 respiratory specimens from 204 unique BMT patients between 01/01/2016 and 01/01/2019 was performed. Age, underlying diagnoses, FA-RP result, reason for FA-RP, and symptoms were abstracted. FA-RP impact on antimicrobial management, scheduled procedures, infection control measures, and hospital admission/discharge were investigated. Impacts of repeat testing were evaluated. Two hundred sixty-nine out of 671 specimens (40%) tested positive; human rhinovirus/enterovirus (hRV/hEV) was the most common (161/269, 60%). The primary reason for FA-RP was URI symptoms (402/671, 60%) with 54% testing positive. One hundred twenty-two out of 671 (18.2%) specimens were from asymptomatic patients; 14 (11.4%) tested positive. FA-RP informed antiviral initiation in 7/19 (36.8%), 7/8 (87.5%), and 5/30 (16.7%) of RSV, influenza, and human parainfluenza cases, respectively. In 11 cases, FA-RP informed azithromycin and ceftriaxone initiation, continuation, or discontinuation. BMT was delayed for three positives (two RSV, one hRV/hEV). In 22 instances, negative FA-RP cleared patients for BMT. In 70% of cases, repeats offered no new clinical information; all negative-to-positive cases had new or worsening respiratory symptoms. FA-RP was ordered on symptomatic and asymptomatic patients, provided rapid diagnosis in > 50% of symptomatic patients, and informed infection control measures for all inpatients and antiviral initiation in > 80% of influenza cases.
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