Comparison of the BioFire FilmArray Pneumonia Panel Plus in quantitative tracheal culture in determining the microbioloical etiology of severe lower respiratory infections in pediatric patients 2019-2022

Abstract

Introduction: The etiologic study of pneumonia in pediatrics is essential for optimizing treatment, improving clinical outcomes, and mitigating antimicrobial resistance. Molecular diagnostic techniques are more sensitive and faster than traditional microbiological tests. Objective: To compare the performance of quantitative tracheal culture and a molecular pneumonia panel in the diagnosis of acute lower respiratory infections (ALRI) and to assess the clinical impact of implementing syndromic panels. Methodology: A prospective study, 2019-2022, of children with ALRI on invasive mechanical ventilation at the Clínica Santa María. Quantitative cultures and a FilmArray® (FA) pneumonia panel were performed on tracheal aspirate, a FA respiratory panel on a nasopharyngeal swab, and blood cultures. Results: 75 patients were included. A virus was detected by the FA pneumonia panel in 49% of cases. 45.3% of cultures and 90.7% of FA pneumonia were positive, with a PPV of 94.1. A resistance gene was detected in six cases. Virus-bacteria coinfection was detected in 52%. 46.2% with a negative culture and a positive FA result for pneumonia had prior use of antimicrobials (p=0.001). Of the eight samples clinically significant for bacteria by FA, only one was detected by culture. In 35 patients (51.4%), the FA result for pneumonia prompted an adjustment in antimicrobial therapy. Conclusions: The FA pneumonia panel improved etiologic detection in children with severe ARI, including those with prior antimicrobial exposure, and facilitated optimization of the treatment. Its correct interpretation must be complemented by microbiological cultures, epidemiology, and clinical judgment.