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Published on: November 28, 2016
Utility of multiplex PCR panels for optimum management of lower respiratory Infections Employing FilmArray Pneumonia
Rajesh Venkitakrishnan1, Bismil Aisha Basheer2, Melcy Cleetus1
1Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India.
Background And Objective:
The objectives of this study were to assess the yield of multiplex PCR testing in LRTI and its utility in antimicrobial streamlining. Establishing the microbial aetiology is of paramount importance for tailored antimicrobial therapy in lower respiratory tract infections (LRTI). Multiplex PCR panels (FilmArray Pneumonia Plus Panel [FAPP]) have been shown to provide better diagnostic yield in LRTI.
Methods:
A total of 103 patients hospitalized with LRTI were enrolled. The culture isolates, their sensitivity pattern, and antimicrobial resistance were noted. Time taken for availability of FAPP results as well as culture positivity was documented. Antibiotic modification made based on identification of the pathogens along with their resistant gene patterns from appropriate samples and time taken to reach that decision was noted and compared between conventional culture and FAPP.
Results:
FAPP detected at least one pathogen in (92/103) of tested specimens. Conventional culture detected at least one pathogen in 36 (34.9%) cases only. The mean duration of antibiotic therapy in FAPP-positive cases was 4.89 ± 1.84 days versus 7.2 ± 3.83 days in cases where FAPP was negative ( P value of 0.019). Similarly, the duration of hospital stay in FAPP-positive cases versus -negative cases was 5.136 ± 1.73 days versus 7.6 ± 3.36 days, respectively ( P value 0.007). Mean turnaround time (TAT) for the FAPP was strikingly low with FAPP. Antimicrobial modification guided by FAPP was achieved in 83 out of 103 patients (80.6%), substantially higher than with conventional culture.
Conclusion:
In hospitalized patients with LRTI, FAPP provided better diagnostic sensitivity, better detection of resistance, faster TAT, higher potential for antimicrobial modification, lesser days of antibiotic use, and shorter hospital stay compared to culture.
