Comparison of a Point-of-Care FilmArray Test to Standard-of-Care Microbiology Test in Diagnosis of Healthcare Associated Infections in a Tertiary Care Pediatric Intensive Care Unit.

Background: Rapid and accurate identification of healthcare associated pathogens is crucial for early diagnosis and treatment of infections. This study aimed to assess the performance of a point-of-care multiplex polymerase chain reaction (PCR) in diagnosis of pathogens and their antibiotic resistance genes in bloodstream infections, pneumonia and meningitis/encephalitis in a pediatric intensive care unit (PICU).

Methods: A retrospective cross-sectional study was conducted on pediatric patients diagnosed with healthcare associated infections at Alexandria University PICU, Egypt. A total of 111 samples from 98 patients were subjected simultaneously to standard-of-care microbiology testing (SOCMT) and molecular testing by BioFire multiplex PCR.

Results: In comparison to SOCMT, the BioFire FilmArray had a better diagnostic yield with broncho-alveolar lavage (BAL) (45 vs. 21) and cerebrospinal fluid (CSF) samples (five vs. none) ( ≤ 0.0001). was the most common pathogen in BAL ( = 19 by BioFire, = 9 by SOCMT) and blood ( = 7, by SOCMT and BioFire) samples, while was the most common in CSF samples. BioFire showed 95.8% overall percent agreement, 100% positive percent agreement and 95.6% negative percent agreement with SOCMT. All phenotypically confirmed resistant isolates had resistance genes by the BioFire FilmArray (100%). The turnaround time (TAT) of positive results by the FilmArray panels was 1-1.5 h in comparison to 48-72 h by SOCMT ( ≤ 0.001).

Conclusions: The results of the current study confirm the utility of the BioFire FilmArray in making early decisions regarding patients' diagnosis and management of infection in the PICU, in terms of rapid TAT and appropriate antimicrobial use.