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Author Spotlight: Advancing Pathogen Detection and Disease Assessment in Real-Time Using M-ROSE
Published on: March 1, 2024
Supporting Clinical Decisions with Rapid Molecular Diagnostic Pneumonia Panel in Pediatric Intensive Care Unit:
Gurkan Bozan1, Yalcin Kara2, Eylem Kiral1
1Pediatric Intensive Care Unit, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye.
Insights
Rapid molecular testing for pneumonia in children significantly aids antibiotic stewardship. This diagnostic panel provides timely results, enabling effective treatment adjustments for pediatric intensive care unit patients with lower respiratory tract infections.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Molecular diagnostics
Background:
- Lower respiratory tract infections (LRTI) are a major global cause of childhood morbidity and mortality.
- Prompt microbiological diagnosis is essential for targeted antibiotic therapy in pediatric pneumonia.
- Evaluating rapid diagnostic tools is crucial for improving patient outcomes in pediatric intensive care units (PICUs).
Purpose of the Study:
- To assess the utility of a rapid molecular diagnostic pneumonia panel (FA-PP) in children with LRTI.
- To determine the impact of FA-PP results on antibiotic treatment strategies in a PICU setting.
- To evaluate the identification of common pathogens and resistance profiles using molecular testing.
Main Methods:
- Retrospective review of 71 results from 46 children diagnosed with LRTI between 2019 and 2023.
- Utilized the BioFire®, FilmArray Pneumonia Panel plus (FA-PP) for rapid molecular detection.
- Analyzed pathogen identification, underlying conditions, mechanical ventilation use, and ventilator-associated pneumonia (VAP) cases.
Main Results:
- The FA-PP detected at least one bacterial pathogen in 57 cases; 77% of children had underlying conditions.
- Commonly identified pathogens included *Pseudomonas aeruginosa*, *Acinetobacter calcoaceticus baumannii complex*, and *Klebsiella pneumoniae*.
- FA-PP results guided antibiotic therapy adjustments in 60.6% of cases (54.5% escalated, 6.1% de-escalated).
Conclusions:
- The FA-PP offers faster results than conventional methods, facilitating prompt clinical decision-making.
- Molecular testing identified resistance profiles, enabling optimized antibiotic treatment strategies (escalation/de-escalation).
- The study highlights the value of molecular diagnostics in managing pediatric pneumonia and VAP in the PICU.
Introduction:
Lower respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. It is crucial to promptly conduct diagnostic investigations in order to determine the microbiological cause of pneumonia, since this is necessary to ensure the appropriate delivery of antibiotic therapy to each individual patient. We evaluated the results of a rapid molecular diagnostic pneumonia panel in children with LRTI in a pediatric intensive care unit (PICU).
Patients And Methods:
Rapid molecular diagnostic pneumonia panel (BioFire®, FilmArray Pneumonia Panel plus; FA-PP) findings (71 results from 46 children) in a tertiary care PICU between 2019 and 2023 were retrospectively reviewed.
Results:
At least one bacterial pathogen was detected in 57 cases. A total of 77% of children had underlying conditions. A total of 70.4% of children needed invasive mechanical ventilation and 54.4% had ventilator-associated pneumonia. Pseudomonas aeruginosa (50.8%), Acinetobacter calcoaceticus baumannii complex (42%), and Klebsiella pneumoniae (38.6%) were the most common pathogens detected with the FA-PP. Of the 33 cases diagnosed with VAP, more than one pathogen was identified in 65.9% of cases, with the most commonly identified bacteria being K. pneumoniae (43.1%), P. aeruginosa (38.6%), and Acinetobacter calcoaceticus baumannii complex (31.8%). According to the FA-PP results, the same antibiotic therapy was continued in 39.4% of cases, escalated in 54.5%, and de-escalated in 6.1%.
Conclusions:
The utilization of the FA-PP has some beneficial effects, including more prompt delivery of findings compared to conventional approaches. Additionally, this approach enables the identification of resistance profiles in children diagnosed with pneumonia in the PICU. Consequently, these test results facilitate the organization of antibiotic treatment strategies, including escalation and de-escalation approaches. The detection of resistance patterns was exclusively determined via the implementation of molecular testing, prompting a reevaluation of the isolation technique in accordance with the obtained data.
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