123 - Utilization of the BioFire® FilmArray® Pneumonia Panel in Critically Ill Patients with Influenza Pneumonia

Background: Severe influenza pneumonia is associated with poor clinical outcomes and may be complicated by bacterial co-infections. Traditional culture techniques may fail to identify organisms, especially if antibiotics were administered prior to culture collection. In critically ill patients, negative cultures may lead to prolonged use of empiric, broad-spectrum antibiotics.

Methods: This is a single-center descriptive study on the use of the BioFire® FilmArray® Pneumonia (PNA) panel in critically ill patients with influenza. All intubated patients diagnosed with influenza pneumonia admitted to an ICU between December 1, 2019 and March 31, 2020 were included for analysis. The purpose of this study was to compare the results from rapid diagnostic testing with traditional culture results, and to describe the impact on time to results and the time to de-escalation of antibiotics.

Results: A total of 21 patients with 22 PNA panels were included. The mean age was 64 years, and 43% were female. Diabetes and COPD were present in 29% and 33%, respectively. A majority of patients (91%) had influenza A. Bacterial co-infection was found in 82% of cases, with all having bacteria identified on the PNA panel. Polymicrobial results from the PNA panel occurred 32% of the time. The most frequently identified bacterial pathogens by PNA panel were S. pneumoniae (41%), MSSA (27%), H. influenzae (14%), and P. aeruginosa (9%). Respiratory cultures had no growth 50% of the time, with MSSA most commonly identified at 23%. P. aeruginosa and MRSA were the only organisms that were detected by both PNA panel and respiratory culture with 100% agreement. PNA panel results were available 5.1 (2.7-11.3) hours after respiratory culture collection, compared to 45.8 (31.5-55.6) hours for culture results. De-escalation of empiric antibiotics occurred 13.2 (1.7-24.0) hours after PNA panel results in the 18 evaluable patients.Table 1: Pathogens Identified by BioFire Pneumonia Panel and Respiratory Culture


Conclusion: The PNA panel identified a high rate of bacterial pathogens in this cohort of critically ill patients with influenza. It also provided actionable results much quicker than traditional respiratory cultures. Further study is needed to evaluate the significance of positive molecular tests when cultures are negative.