Performance evaluation of a PCR panel (FilmArray® Pneumonia Plus) for detection of respiratory bacterial pathogens in respiratory specimens: A systematic review and meta-analysis

Anne-Clotilde Moy; Antoine Kimmoun; Thomas Merkling; Béatrice Berçot; François Caméléna; Thibaut Poncin; Benjamin Deniau; Alexandre Mebazaa; Emmanuel Dudoignon; François Dépret; PCR Multiplex Study group (PMS group)

doi:10.1016/j.accpm.2023.101300

Performance evaluation of a PCR panel (FilmArray® Pneumonia Plus) for detection of respiratory bacterial pathogens in respiratory specimens: A systematic review and meta-analysis

Anaesth Crit Care Pain Med. 2023 Dec;42(6):101300. doi: 10.1016/j.accpm.2023.101300. Epub 2023 Sep 12.

Collaborators

PCR Multiplex Study group (PMS group):
Nabil Gastli⁷, Vincent Cattoir⁸, Naouale Maataoui⁹, Laurence Armand-Lefèvre⁹, Barend Mitton¹⁰, Jonathan Hoover¹¹, John R Greenland¹², Brunella Posteraro¹³, Maurizio Sanguinetti¹⁴, Evdoxia Kyriazopoulou¹⁵, Evangelos J Giamarellos-Bourboulis¹⁵, Giulia Menchinelli¹⁴, Brune Joannard¹⁶

Affiliations

¹ Department of Anesthesiology, Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France.
² Intensive Care Medicine Brabois, CHRU de Nancy, INSERM U1116, Université de Lorraine, Nancy, France; INSERM UMR-S 942, MASCOT, Université de Paris, Paris, France.
³ Nancy Clinical Investigation Centre, INSERM 1433, CHRU Nancy, Université de Lorraine, Nancy, France.
⁴ Department of Microbiology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France.
⁵ Department of Anesthesiology, Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France.
⁶ Department of Anesthesiology, Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France. Electronic address: emmanuel.dudoignon@aphp.fr.
⁷ Department of Microbiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁸ Clinical Microbiology Laboratory Unit, Pontchaillou University Hospital, Rennes, France; INSERM U1230, University Hospital, Rennes, France.
⁹ Department of Microbiology, Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM, IAME, F-75006, University of Paris, Paris, France.
¹⁰ Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa.
¹¹ Department of Medicine, University of California, San Francisco, CA, USA.
¹² Department of Medicine, University of California, San Francisco, CA, USA; Medical Service, San Francisco VA Health Care System, San Francisco, CA, USA.
¹³ Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of Sacred Heart, Rome, Italy; Department of Medical and Surgical Sciences, Agostino Gemelli University Hospital, Rome, Italy.
¹⁴ Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of Sacred Heart, Rome, Italy; Department of Laboratory and Infectious Disease Sciences, Agostino Gemelli University Hospital, Rome, Italy.
¹⁵ Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University.
¹⁶ Department of microbiology, Saint Louis Hospital Assistance Publique-Hôpitaux de Paris, France.

PMID: 37709201
DOI: 10.1016/j.accpm.2023.101300

Abstract

Background: Accuracy and timing of antibiotic therapy remain a challenge for lower respiratory tract infections. New molecular techniques using Multiplex Polymerase Chain Reaction, including the FilmArray® Pneumonia Plus Panel [FAPP], have been developed to address this. The aim of this study is to evaluate the FAPP diagnostic performance for the detection of the 15 typical bacteria of the panel from respiratory samples in a meta-analysis from a systematic review.

Methods: We searched PubMed and EMBASE from January 1, 2010, to December 31, 2022, and selected any study on the FAPP diagnostic performance on respiratory samples compared to the reference standard, bacterial culture. The main outcome was the overall diagnostic accuracy with sensitivity and specificity. We calculated the log Diagnostic Odds Ratio and analyzed performance for separate bacteria, antimicrobial resistance genes, and according to the sample type. We also reported the FAPP turnaround time and the out-of-panel bacteria number and species. This study is registered with PROSPERO (CRD42021226280).

Results: From 10 317 records, we identified 30 studies including 8 968 samples. Twenty-one were related to intensive care. The overall sensitivity and specificity were 94% [95% Confidence Interval (CI) 91-95] and 98% [95%CI 97-98], respectively. The log Diagnostic Odds Ratio was 6.35 [95%CI 6.05-6.65]. 9.3% [95%CI 9.2-9.5] of bacteria detected in culture were not included in the FAPP panel.

Conclusion: This systematic review reporting the FAPP evaluation revealed a high accuracy. This test may represent an adjunct tool for pulmonary bacterial infection diagnostic and antimicrobial stewardship. Further evidence is needed to assess the impact on clinical outcome.

Keywords: Multiplex PCR; Performance; Polymerase chain reaction; Respiratory tract infection; Syndromic panel.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Bacteria / genetics
Bacterial Infections*
Humans
Multiplex Polymerase Chain Reaction / methods
Pneumonia*
Respiratory Tract Infections* / diagnosis
Respiratory Tract Infections* / microbiology