Original Article

Evaluation PCR panel of the FilmArray® pneumonia plus for pathogen detection of ventilator-associated pneumonia in children and its impact on therapeutic management

Abstract

Background and Objectives: Ventilator-associated pneumonia (VAP) is the second most common nosocomial infection in pediatric intensive care units. The aim of this study was to evaluate the contribution of multiplex PCR in the diagnosis of VAP and its impact on the clinical and prognostic outcome of children in the ICU.
Materials and Methods: This is a prospective observational study from March to November 2021, including bronchial samples collected from 38 intubated children hospitalized in ICU. The detection of respiratory pathogens was performed by the FilmArray® Pneumonia Panel plus (FAPP).
Results: Multiplex PCR (mPCR) detected exclusively 46 potentially pathogenic bacteria, giving a sensitivity of 93%, specificity of 90%, negative predictive value of 100%, and positive predictive value of 23%. Overall, the sensitivity of mPCR was higher for Gram-negative bacteria (100%) than Gram-positive (92%). Bacterial etiology was the most frequent (69.3%), represented mainly by Moraxella catarrhalis (11.4%), followed by viral etiology (30.7%), with Rhinovirus/Enterovirus as the most prevalent virus. FAPP enabled a change in antibiotic therapy in 39.5% of the patients, with a 73.3% survival rate.
Conclusion: This study highlights the importance of mPCR in diagnosing VAP and improving antimicrobial therapy.

1. Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, et al. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 2013; 381: 1417‑1429.
2. GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 2017; 17: 1133‑1161.
3. Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev 2007; 20: 409‑425.
4. Peiffer-Smadja N, Bouadma L, Mathy V, Allouche K, Patrier J, Reboul M, et al. Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia. Crit Care 2020; 24: 366.
5. Chang I, Schibler A. Ventilator associated Pneumonia in children. Paediatr Respir Rev 2016; 20: 10‑16.
6. Vincent J-L, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 302: 2323‑2329.
7. Bhat N, O’Brien KL, Karron RA, Driscoll AJ, Murdoch DR, Pneumonia Methods Working Group. Use and evaluation of molecular diagnostics for Pneumonia etiology studies. Clin Infect Dis 2012; 54 Suppl 2(Suppl_2): S153‑8.
8. Ozongwu C, Personne Y, Platt G, Jeanes C, Aydin S, Kozato N, et al. The Unyvero P55 ‘sample-in, answer-out’ pneumonia assay: A performance evaluation. Biomol Detect Quantif 2017; 13: 1‑6.
9. Lee SH, Ruan S-Y, Pan S-C, Lee T-F, Chien J-Y, Hsueh P-R. Performance of a multiplex PCR pneumonia panel for the identification of respiratory pathogens and the main determinants of resistance from the lower respiratory tract specimens of adult patients in intensive care units. J Microbiol Immunol Infect 2019; 52: 920‑928.
10. Monard C, Pehlivan J, Auger G, Alviset S, Tran Dinh A, Duquaire P, et al. Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia. Crit Care 2020; 24: 434.
11. Armand-Lefèvre L, Angebault C, Barbier F, Hamelet E, Defrance G, Ruppé E, et al. Emergence of imipenem-resistant Gram-negative Bacilli in intestinal flora of intensive care patients. Antimicrob Agents Chemother 2013; 57: 1488‑1495.
12. Lamrani Hanchi A, Guennouni M, Rachidi M, Benhoumich T, Bennani H, Bourrous M, et al. Epidemiology of respiratory pathogens in children with severe acute respiratory infection and impact of the multiplex PCR film array respiratory panel: A 2-year study. Int J Microbiol 2021; 2021: 2276261.
13. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated Pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society. Clin Infect Dis 2016; 63(5): e61‑e111.
14. Bassetti M, Righi E, Vena A, Graziano E, Russo A, Peghin M. Risk stratification and treatment of ICU-acquired pneumonia caused by multidrug- resistant/extensively drug-resistant/pandrug-resistant bacteria. Curr Opin Crit Care 2018; 24: 385‑393.
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IssueVol 15 No 1 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v15i1.11914
Keywords
Multiplex polymerase chain reaction; Ventilator-associated pneumonia; Children; Intensive care units; Antimicrobial stewardship
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Debbagh F, Ben Houmich T, Guennouni M, Sahraoui H, Lamrani Hanchi A, Mouaffak Y, Younous S, Soraa N. Evaluation PCR panel of the FilmArray® pneumonia plus for pathogen detection of ventilator-associated pneumonia in children and its impact on therapeutic management. Iran J Microbiol. 2023;15(1):19-26.