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Abstract：
Antimicrobial resistance (AMR), including multidrug (MDR) and extensively drug-resistant (XDR) bacteria, is an essential consideration in the prevention and management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). In the AMR era, the clinical utility of the BioFire FilmArray Pneumonia Panel Plus (BFPP) to diagnose HAP/VAP has not been thoroughly evaluated.
We enrolled adult hospitalized patients with HAP or VAP at Siriraj Hospital and Saraburi Hospital from July 2019-October 2021. Respiratory samples were collected for standard microbiological assays, antimicrobial susceptibility testing (AST), and the BFPP analysis.
Of 40 subjects, 21 were men. The median duration of HAP/VAP diagnoses was 10.5 (5, 21.5) days, and 36 endotracheal aspirate and 4 sputum samples were collected. Standard cultures isolated 54 organisms-A. baumannii (37.0%), P. aeruginosa (29.6%), and S. maltophilia (16.7%). 68.6% of Gram Negatives showed an MDR or XDR profile. BFPP detected 77 bacterial targets-A. baumannii 32.5%, P. aeruginosa 26.3%, and K. pneumoniae 17.5%. Of 28 detected AMR gene targets, CTX-M (42.5%), OXA-48-like (25%), and NDM (14.3%) were the most common. Compared with standard testing, the BFPP had an overall sensitivity of 98% (88-100%), specificity of 81% (74-87%), positive predictive value of 60% (47-71%), negative predictive value of 99% (96-100%), and kappa (κ) coefficient of 0.64 (0.53-0.75). The concordance between phenotypic AST and detected AMR genes in Enterobacterales was 0.57. There was no concordance among A. baumannii, P. aeruginosa, and S. aureus.
The BFPP has excellent diagnostic sensitivity to detect HAP/VAP etiology. The absence of S. maltophilia and discordance of AMR gene results limit the test performance.
We enrolled adult hospitalized patients with HAP or VAP at Siriraj Hospital and Saraburi Hospital from July 2019-October 2021. Respiratory samples were collected for standard microbiological assays, antimicrobial susceptibility testing (AST), and the BFPP analysis.
Of 40 subjects, 21 were men. The median duration of HAP/VAP diagnoses was 10.5 (5, 21.5) days, and 36 endotracheal aspirate and 4 sputum samples were collected. Standard cultures isolated 54 organisms-A. baumannii (37.0%), P. aeruginosa (29.6%), and S. maltophilia (16.7%). 68.6% of Gram Negatives showed an MDR or XDR profile. BFPP detected 77 bacterial targets-A. baumannii 32.5%, P. aeruginosa 26.3%, and K. pneumoniae 17.5%. Of 28 detected AMR gene targets, CTX-M (42.5%), OXA-48-like (25%), and NDM (14.3%) were the most common. Compared with standard testing, the BFPP had an overall sensitivity of 98% (88-100%), specificity of 81% (74-87%), positive predictive value of 60% (47-71%), negative predictive value of 99% (96-100%), and kappa (κ) coefficient of 0.64 (0.53-0.75). The concordance between phenotypic AST and detected AMR genes in Enterobacterales was 0.57. There was no concordance among A. baumannii, P. aeruginosa, and S. aureus.
The BFPP has excellent diagnostic sensitivity to detect HAP/VAP etiology. The absence of S. maltophilia and discordance of AMR gene results limit the test performance.
摘要：
抗菌素耐药性（AMR），包括多药（MDR）和广泛耐药（XDR）细菌，是预防和管理医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）的重要考虑因素。在AMR时代,BioFireFilmArray肺炎联合小组(BFPP)诊断HAP/VAP的临床效用尚未得到彻底评估.
从2019年7月至2021年10月，我们在Siriraj医院和Saraburi医院招募了患有HAP或VAP的成年住院患者。收集呼吸道样本进行标准微生物测定，抗菌药物敏感性试验（AST），和BFPP分析。
在40个科目中,21是男人HAP/VAP诊断的中位持续时间为10.5（5，21.5）天，收集36例气管内抽吸物和4例痰标本。标准培养物分离出54种生物体-A。鲍曼不动杆菌(37.0%)，铜绿假单胞菌（29.6%），和嗜麦芽链球菌（16.7%）。68.6%的革兰氏阴性显示MDR或XDR谱。BFPP检测到77个细菌靶标-A。鲍曼不动杆菌32.5%,铜绿假单胞菌26.3%，和肺炎克雷伯菌17.5%。在检测到的28个AMR基因靶标中，CTX-M(42.5%),OXA-48样（25%），最常见的是NDM（14.3%）。与标准测试相比，BFPP的总体灵敏度为98%(88-100%)，特异性为81%（74-87%），阳性预测值为60%（47-71%），阴性预测值为99%（96-100%），κ(κ)系数为0.64(0.53-0.75)。在肠杆菌中，表型AST与检测到的AMR基因之间的一致性为0.57。鲍曼不动杆菌之间没有一致性，铜绿假单胞菌,和金黄色葡萄球菌。
BFPP对检测HAP/VAP病因具有优异的诊断灵敏度。嗜麦芽窄食链球菌的缺失和AMR基因结果的不一致限制了测试性能。
从2019年7月至2021年10月，我们在Siriraj医院和Saraburi医院招募了患有HAP或VAP的成年住院患者。收集呼吸道样本进行标准微生物测定，抗菌药物敏感性试验（AST），和BFPP分析。
在40个科目中,21是男人HAP/VAP诊断的中位持续时间为10.5（5，21.5）天，收集36例气管内抽吸物和4例痰标本。标准培养物分离出54种生物体-A。鲍曼不动杆菌(37.0%)，铜绿假单胞菌（29.6%），和嗜麦芽链球菌（16.7%）。68.6%的革兰氏阴性显示MDR或XDR谱。BFPP检测到77个细菌靶标-A。鲍曼不动杆菌32.5%,铜绿假单胞菌26.3%，和肺炎克雷伯菌17.5%。在检测到的28个AMR基因靶标中，CTX-M(42.5%),OXA-48样（25%），最常见的是NDM（14.3%）。与标准测试相比，BFPP的总体灵敏度为98%(88-100%)，特异性为81%（74-87%），阳性预测值为60%（47-71%），阴性预测值为99%（96-100%），κ(κ)系数为0.64(0.53-0.75)。在肠杆菌中，表型AST与检测到的AMR基因之间的一致性为0.57。鲍曼不动杆菌之间没有一致性，铜绿假单胞菌,和金黄色葡萄球菌。
BFPP对检测HAP/VAP病因具有优异的诊断灵敏度。嗜麦芽窄食链球菌的缺失和AMR基因结果的不一致限制了测试性能。
