Multiplex PCR-based rapid pathogen identification in acute cholecystitis using the FilmArray BCID2 panel.

Area of Science:

• Microbiology
• Infectious Diseases
• Molecular Diagnostics

Background:

• Acute biliary infections pose significant clinical challenges, with delayed treatment potentially leading to adverse outcomes and antimicrobial resistance.
• Accurate and rapid pathogen identification is crucial for effective management of these serious infections.

Purpose of the Study:

• To evaluate the performance of the FilmArray® Blood Culture Identification 2 (BCID2) panel for rapid pathogen detection in bile samples from patients with acute cholecystitis.
• To assess the utility of multiplex PCR in improving diagnosis and guiding therapy for biliary tract infections.

Main Methods:

• Bile samples from 77 patients with acute cholecystitis were analyzed using both conventional culture and the BCID2 multiplex PCR panel.
• Conventional culture served as the reference standard to determine the accuracy of the BCID2 panel, calculating metrics like positive percent agreement (PPA) and negative percent agreement (NPA).

Main Results:

• The BCID2 panel demonstrated high accuracy (92.2%) in identifying pathogens directly from bile samples.
• Sensitivity (PPA) for detecting targetable isolates was 82.4%, with 100% specificity (NPA).
• Detection rates were higher in polymicrobial infections (94.1%) and with increased bacterial load (>10^6 CFU/mL).

Conclusions:

• Multiplex PCR testing with the BCID2 panel offers a rapid and accurate method for identifying bacterial pathogens in bile.
• This molecular approach can facilitate earlier targeted antimicrobial therapy and support antimicrobial stewardship in acute biliary infections.