Silcock Robyn, Clifford Vanessa, Osowicki Joshua, Gelbart Ben
From the Infectious Diseases, Queensland Children's Hospital, Brisbane, Queensland.
Laboratory Services.
Pediatr Infect Dis J. 2025 Apr 1;44(4):371-375. doi: 10.1097/INF.0000000000004629. Epub 2024 Nov 11.
Lower respiratory tract infections (LRTIs) remain a leading cause of community-acquired and nosocomial infection in children and a common indication for antimicrobial use and intensive care admission. Determining the causative pathogen for LRTIs is difficult and traditional culture-based methods are labor- and time-intensive. Emerging molecular diagnostic tools may identify pathogens and detect antimicrobial resistance more quickly, to enable earlier targeted antimicrobial therapy.
This is a single-center, prospective observational laboratory study evaluating the use of the Biofire FilmArray pneumonia panel (FA-PP) (BioFire Diagnostics, Salt Lake City, UT) for bronchoalveolar lavage specimens from mechanically ventilated children admitted with suspected or presumed pneumonia. We aimed to determine its feasibility and utility for identifying pathogens, antimicrobial resistance and its potential influence on antibiotic prescribing.
We analyzed 50 samples taken from 41 children with a median age of 6 months. Positive agreement between culture and FA-PP was 83% and negative agreement was 76%. Agreement between FA-PP ( mecA/C or MREJ ) and culture was high for methicillin-resistant Staphylococcus aureus . In 3 cases, extended-spectrum beta-lactamase-producing Gram-negative organisms were detected by culture and not FA-PP. Hypothetically, FA-PP results would have affected antimicrobial prescribing in approximately half the cases (24, 48%).
FA-PP is a useful adjunct to traditional culture methods in mechanically ventilated children with LRTIs and may influence clinical decision-making regarding antibiotic escalation or stewardship.
下呼吸道感染（LRTIs）仍然是儿童社区获得性感染和医院感染的主要原因，也是使用抗菌药物和入住重症监护病房的常见指征。确定LRTIs的致病病原体很困难，传统的基于培养的方法既耗费人力又耗时。新兴的分子诊断工具可能会更快地识别病原体并检测抗菌药物耐药性，从而实现更早的靶向抗菌治疗。
这是一项单中心、前瞻性观察性实验室研究，评估BioFire FilmArray肺炎检测板（FA-PP）（BioFire Diagnostics，盐湖城，犹他州）在对因疑似或确诊肺炎而入院的机械通气儿童的支气管肺泡灌洗标本中的应用。我们旨在确定其在识别病原体、抗菌药物耐药性方面的可行性和实用性，以及其对抗生素处方的潜在影响。
我们分析了从41名儿童身上采集的50份样本，这些儿童的中位年龄为6个月。培养结果与FA-PP结果的阳性符合率为83%，阴性符合率为76%。对于耐甲氧西林金黄色葡萄球菌，FA-PP（mecA/C或MREJ）与培养结果之间的符合率很高。在3例病例中，培养检测到产超广谱β-内酰胺酶的革兰氏阴性菌，而FA-PP未检测到。假设FA-PP结果会影响大约一半病例（24例，48%）的抗菌药物处方。
对于患有LRTIs的机械通气儿童，FA-PP是传统培养方法的有用辅助手段，可能会影响关于抗生素升级或管理的临床决策。
