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Clinical significance of negative BioFire® pneumonia panel in ICU: Diagnosis, management, and outcomes

Thibault Nardy1, Emilie Rondinaud2, Julien Dessajan1

  • 1Medical and Infectious Diseases Intensive Care Unit, Hospital Bichat-Claude Bernard, Université Paris Cité, AP-HP, Paris, France.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|April 1, 2026
PubMed
Abstract

Insights

Negative results from the BioFire® FilmArray® Pneumonia Panel (FA-PP) do not rule out hospital-acquired (HAP) or ventilator-associated pneumonia (VAP) in ICU patients. Gram stain is crucial for accurate diagnosis and antimicrobial stewardship.

Area of Science:

  • Critical Care Medicine
  • Clinical Microbiology
  • Infectious Diseases

Background:

  • Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant challenges in intensive care units (ICUs).
  • The BioFire® FilmArray® Pneumonia Panel (FA-PP) is a multiplex PCR test used for rapid pathogen detection in suspected pneumonia.
  • Understanding the clinical utility of negative FA-PP results is crucial for appropriate patient management and antimicrobial stewardship.

Purpose of the Study:

  • To assess the clinical significance of negative FA-PP results in ICU patients with suspected HAP/VAP.
  • To evaluate the impact of negative FA-PP results on diagnosis, antimicrobial management, and patient outcomes.
  • To identify factors associated with false-negative FA-PP results in this patient population.

Main Methods:

  • A retrospective single-center study was conducted from April 2021 to July 2023.
  • Included were 190 critically ill patients with negative FA-PP results from deep respiratory samples.
  • Patients with microbiologically confirmed HAP/VAP were compared to those without confirmed infections.

Main Results:

  • Of 190 patients, 36% had culture-confirmed HAP/VAP. Gram-negative bacilli (GNB) on Gram stain predicted true infection (OR=3.08).
  • The FA-PP false-negative rate for detectable bacteria was 12%, primarily Klebsiella pneumoniae and Pseudomonas aeruginosa.
  • Non-targeted GNBs comprised 27% of confirmed cases. Recent broad-spectrum antibiotic exposure reduced infection likelihood (OR=0.28).

Conclusions:

  • Negative FA-PP results do not exclude HAP/VAP, particularly when non-targeted GNBs are involved or with prior antibiotic exposure.
  • Gram stain remains a valuable complementary diagnostic tool alongside molecular testing.
  • Integrated diagnostic strategies are essential for optimizing antimicrobial stewardship in ICU settings.
Keywords:
Antibiotic stewardshipFilmArray pneumonia panelHospital-acquired pneumoniaMultiplex PCRVentilator-associated pneumonia

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