Clinical impact of a commercial multiplex pathogen panel for the detection of bacteria in sputum specimens from non-ICU patients with suspected lower respiratory tract infection.

Objective: To evaluate the clinical impact of the BioFire® FilmArray® Pneumonia Panel (BFPP) in sputum specimens from non-intensive care unit (ICU) patients with suspected lower respiratory tract infection. Design: Retrospective cohort study. Setting: 1400-bed tertiary referral academic medical center. Methods: Patients who had a sputum specimen with BFPP and standard of care (SOC) culture between 9/1/2022 and 8/31/2024 while on a non-ICU floor were included. An antibiotic change evaluation of actual versus theoretically possible therapy changes was completed at two time points, after BFPP results and after SOC results, overall and by various characteristics, in addition to an assessment of the appropriateness of antibiotic regimens. Results: 189 specimens were included. 48.7% of theoretical changes were acted upon based on BFPP results compared to 87.8% of theoretical changes acted upon based on SOC results. Actual compared to theoretical de-escalation of gram-positive agents occurred more frequently compared to gram-negative agents post-BFPP (43.1% vs 32%) and post-SOC (60.5% vs 38.7%). De-escalation was more frequent in non-neutropenic patients compared to neutropenic patients (39.5% vs 26.1% post-BFPP; 54.7% vs 21.1% post-SOC) and in medicine floor patients compared to oncology floor patients (52.5% vs 23.8% post-BFPP; 72.5% vs 30.2% post-SOC). Appropriateness of antibiotic regimens was higher post-SOC results (77.8%) compared to post-BFPP results (66.1%). Conclusions: Higher rates of theoretical antibiotic changes were acted upon post-SOC results compared to post-BFPP results, suggesting a disconnect between BFPP results and provider action. Further research is needed to assess factors associated with actionability of the BFPP.