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Practice Versus Potential: The Impact of the BioFire FilmArray Pneumonia Panel on Antibiotic Use in Children
Alexander S Plattner1,2, Christine R Lockowitz3, Rebekah Dumm4
1Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Insights
The BioFire FilmArray Pneumonia Panel (BFPP) in children rarely changed antibiotic use, despite potential. This study highlights limited impact on antimicrobial stewardship in pediatric lower respiratory tract infections.
Area of Science:
- Infectious Diseases
- Pediatric Critical Care
- Antimicrobial Stewardship
Background:
- The BioFire FilmArray Pneumonia Panel (BFPP) is a multiplex PCR test for diagnosing lower respiratory tract infections.
- BFPP has been suggested to aid antimicrobial stewardship efforts.
- Limited real-world data exists on BFPP implementation, especially in pediatric populations.
Purpose of the Study:
- To characterize the utilization of the BFPP in pediatric patients.
- To evaluate the impact of BFPP results on antibiotic prescribing practices.
Main Methods:
- Retrospective cohort study of children hospitalized at St. Louis Children's Hospital.
- Included all BFPP tests from September 2021 to August 2022.
- Assessed changes in antibiotic therapy within 24 hours of BFPP results compared to clinician assessment.
Main Results:
- 169 tests from 126 pediatric patients were analyzed; most from intensive care units via tracheal aspirates.
- Only 51% of tests were indicated for respiratory failure or suspected pneumonia.
- While 80% of results had potential to alter antibiotic therapy, only 46% resulted in actual changes, with escalation more frequent than de-escalation.
Conclusions:
- The majority of BFPP tests in this pediatric cohort were performed on tracheal aspirates.
- Less than half of BFPP tests led to a change in antibiotic therapy, indicating limited impact on stewardship.
- Further research is needed to optimize BFPP use for effective antimicrobial stewardship in children.
Background:
The BioFire FilmArray Pneumonia Panel (BFPP), a multiplex PCR panel for the diagnosis of lower respiratory tract infections, has been proposed as a tool for antimicrobial stewardship. Few studies evaluate real-world implementation of the BFPP and no studies focus exclusively on children. Our institution implemented BFPP testing without restrictions.
Methods:
We conducted a retrospective cohort study in children hospitalized at St. Louis Children's Hospital to (1) characterize the use of the BFPP in pediatric patients and (2) assess how results impacted antibiotic use. We included all BFPP tests obtained during the first year after the introduction of the test, September 2021 through August 2022. The primary outcome was change in antibiotic therapy within 24 hours of results, which was compared to the potential change in antibiotic therapy determined by two infectious diseases clinicians.
Results:
One hundred sixty-nine tests from 126 patients were included. Nine patients were immunocompromised and 19 had chronic tracheostomy. The majority of tests were sent from tracheal aspirate specimens (92%) and from patients in an intensive care unit (94%). Only 51% of tests were obtained due to respiratory failure or suspected pneumonia. For 80% of test results, there was potential to change antibiotics, but change occurred in only 46% of tests in practice. Antibiotic escalation was more common (26%) than de-escalation (15%) or discontinuation (4.1%).
Conclusions:
In a cohort of pediatric patients tested with the BFPP, the majority of tests were sent from tracheal aspirates and less than half of tests were associated with a change in antibiotics.
