Diagnostic BioFire® FilmArray® Pneumonia Panel Plus versus standard microbial culture in bronchiectasis exacerbations

The diagnostic performance of the BioFire® FilmArray® Pneumonia Panel Plus (FAPP) compared to standard microbial culture (SMC) during bronchiectasis (BE) exacerbations is unknown.

To compare the microbiological diagnostic performance between FAPP and SMC during BE exacerbations.

A prospective observational study was conducted in adults with a BE exacerbation at the Hospital Clinic of Barcelona (Spain) June 2020 to April 2022. All sputum samples underwent processing using both the FAPP and SMC (n = 109) but we focused in good quality samples (n = 73).

The FAPP detected pathogens in a higher percentage (n = 64, 88%) compared to SMC (n = 41, 56%). This increase was higher in samples from patients receiving empiric antibiotic treatment (n = 24, 89% and n = 10, 37%, for FAPP and SMC, respectively). The FAPP identified in 29 sputum (40%) more than one microorganism, while by SMC were all monomicrobial (n = 73, 100%). In 93 out of 109 BE exacerbations (85%), clinicians used the FAPP results for treatment decisions. According to the pathogen found by FAPP, immediate change of empiric treatment occurred in 15 out of 38 patients (40%) receiving empiric antimicrobial at time of exacerbation. Early treatment adequacy likely contributed to the low rate of treatment modifications observed by day 5 of exacerbation when the overall rate of treatment changes was low (8%) and treatment failure was noted in only 2% of the total population.

The FAPP demonstrated significantly higher microbiological diagnostic performance compared to SMC, regardless of prior antibiotic exposure. Improved pathogen detection using FAPP enabled more accurate initial antimicrobial therapy, which was associated with low rates of treatment failure.