RAPID-CARE: Rapid Antibiotic Optimization in the ICU After Implementation of a Pneumonia Multiplex PCR Test-A...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Clinical Microbiology

Background:

• Lower respiratory tract infections (LRTIs) are common in intensive care units (ICUs), leading to broad-spectrum antibiotic use.
• Rapid multiplex PCR assays offer potential improvements in pathogen detection and antibiotic stewardship over conventional cultures.

Purpose of the Study:

• To evaluate the real-world impact of the BioFire FilmArray Pneumonia Panel Plus (FA-PNEU) on antimicrobial management for suspected nosocomial LRTIs.
• To assess the diagnostic accuracy of FA-PNEU compared to conventional culture.

Main Methods:

• Prospective observational cohort study in a tertiary ICU (Madrid, Spain) from April 2021 to March 2025.
• Included adult patients with suspected hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), or ventilator-associated tracheobronchitis (VAT).
• Analyzed diagnostic accuracy and changes in antibiotic prescribing based on FA-PNEU results versus conventional culture.

Main Results:

• FA-PNEU showed high sensitivity (93.4%) and negative predictive value (97.9%), but moderate specificity (65.0%) and low positive predictive value (36.5%).
• False positives were frequent in patients with prior antibiotic therapy.
• FA-PNEU directly influenced antibiotic therapy decisions in 57.6% of cases, particularly in guiding de-escalation or discontinuation.

Conclusions:

• The FA-PNEU panel provides rapid, high-sensitivity diagnostics for critically ill patients with suspected nosocomial LRTIs.
• The assay significantly influences antimicrobial prescribing, with key value in ruling out bacterial infections and supporting stewardship efforts.
• Interpretation of FA-PNEU results requires consideration of the complete clinical and microbiological context.