Real-World Evaluation of a Rapid Multiplex PCR Panel in Adults Hospitalized With COPD Exacerbations

The clinical utility of rapid multiplex PCR panels in patients with exacerbation of COPD (ECOPD) is undefined. We aimed to assess the clinical relevance of the BioFire FilmArray pneumonia plus panel (FAPP) testing in ECOPD in a real-world hospital setting.

A prospective observational study was conducted on 74 hospitalized ECOPD patients. Spontaneous sputum samples were analysed using FAPP alongside standard-of-care (SOC) tests. Microbial profiles were assessed, and patients were phenotyped based on FAPP findings.

FAPP significantly increased the proportion of patients with identifiable pathogens from 36% by SOC tests to 78% (increase of 42%, p < 0.0001), primarily contributed by increased bacterial detection (increase of 47%, p < 0.0001), with a shorter turnaround time (median 6 h vs. 75 h, p < 0.0001). Staphylococcus aureus was the most prevalent bacteria, while Haemophilus influenzae predominated at high abundance (10⁶-≥ 10⁷ copies/ml). Respiratory viruses were detected in 27%, most frequently Influenza A. All in-panel cultured bacteria were concordantly detected by FAPP at high abundance. High-abundance bacterial detection was associated with significantly higher host immune response markers. The bacterial-predominant phenotype was associated with higher exacerbation severity, while the purely eosinophilic phenotype had a lower 180-day treatment failure rate compared to the unclassified phenotype.

FAPP significantly enhances microbial detection in patients with ECOPD. Appropriate utilization of FAPP might guide antibiotic decision-making and phenotyping in ECOPD. The potential of sputum multiplex PCR-based strategy to guide antibiotic decisions in ECOPD merits further research.