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应用 FilmArray 血培养鉴定板快速鉴定呼吸机相关性肺炎的病原体。

Application of BioFire FilmArray Blood Culture Identification panel for rapid identification of the causative agents of ventilator-associated pneumonia.

机构信息

Clinical Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Seville, Spain.

Infectious Diseases and Clinical Microbiology Unit, Seville, Spain.

出版信息

Clin Microbiol Infect. 2018 Nov;24(11):1213.e1-1213.e4. doi: 10.1016/j.cmi.2018.06.001. Epub 2018 Jun 12.

Abstract

OBJECTIVE

To evaluate the ability of the BioFire FilmArray Blood Culture Identification (BCID) panel to rapidly detect pathogens producing late-onset ventilator-associated pneumonia (VAP), a severe infection often produced by Gram-negative bacteria. These microorganisms are frequently multidrug resistant and typically require broad-spectrum empiric treatment.

METHODS

In the context of an international multicentre clinical trial (MagicBullet), respiratory samples were collected at the time of suspicion of VAP from 165 patients in 32 participating hospitals in Spain, Greece and Italy. Microorganisms were identified using the BCID panel and compared with results obtained by conventional microbiologic techniques.

RESULTS

Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were the most commonly identified species, representing 54.7% (70/128) of microorganisms. The BCID panel showed high global specificity (98.1%; 95% confidence interval, 96-100) and negative predictive values (96.6%) and a global sensitivity and positive predictive value of 78.6% (95% confidence interval, 70-88) and 87.3%, respectively, for these microorganisms. Importantly, the BCID panel provided results in only 1 hour directly from respiratory samples with minimal sample processing times.

CONCLUSIONS

The BCID panel may have clinical utility in rapidly ruling out microorganisms causing VAP, specifically multidrug-resistant Gram-negative species. This could facilitate the optimization of empiric treatment.

摘要

目的

评估生物梅里埃 FilmArray 血培养鉴定(BCID)板快速检测产迟发性呼吸机相关性肺炎(VAP)病原体的能力,VAP 是一种严重感染,通常由革兰氏阴性菌引起。这些微生物通常具有多重耐药性,通常需要广谱经验性治疗。

方法

在一项国际多中心临床试验(MagicBullet)中,从西班牙、希腊和意大利的 32 家参与医院的 165 名患者中,在疑似 VAP 时采集呼吸道样本。使用 BCID 板鉴定微生物,并与常规微生物学技术的结果进行比较。

结果

铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌是最常见的鉴定物种,占 54.7%(70/128)的微生物。BCID 板显示出高的全球特异性(98.1%;95%置信区间,96-100)和阴性预测值(96.6%),以及 78.6%(95%置信区间,70-88)的全球敏感性和阳性预测值和 87.3%,分别用于这些微生物。重要的是,BCID 板仅需 1 小时即可直接从呼吸道样本中获得结果,并且样本处理时间最短。

结论

BCID 板可能具有快速排除引起 VAP 的微生物的临床实用性,特别是多重耐药的革兰氏阴性菌。这可以促进经验性治疗的优化。

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