Lee S.H.SHENG-YUAN RUANSUNG-CHING PANLee T.-F.JUNG-YIEN CHIENPO-REN HSUEH2020-03-272020-03-2720191684-1182https://scholars.lib.ntu.edu.tw/handle/123456789/479666Background: Timely diagnostic investigation to establish the microbial etiology of pneumonia is essential to ensure the administration of effective antibiotic therapy to individual patients. Methods: We evaluated a multiplex PCR assay panel, the FilmArray? pneumonia panel (FilmArray PP, BioFire Diagnostics), for detection of 35 respiratory pathogens and resistance determinants and compared the performance of the standard-of-care test in intensive care unit patients with lower respiratory tract infections. Results: Among the 59 endotracheal aspirates and bronchoalveolar lavage specimens obtained from 51 adult patients, FilmArray PP was effective in detecting respiratory bacterial pathogens with an overall positive percent agreement of 90% (95% confidence interval [CI], 73.5–97.9%) and negative percent agreement of 97.4% (95% CI, 96.0–98.4%). FilmArray PP semi-quantitative reporting demonstrated a concordance rate of 53.6% for the culture-positive specimens and 86.3% for the culture-negative specimens. FilmArray PP detected 16 viral targets, whereas the conventional viral isolation failed, except influenza A, which showed 100% concordance with PCR. Coinfections were detected in 42.3% of the specimens. Substantial discrepancies were observed in identifying antimicrobial resistance gene targets and in the susceptibility testing. However, FilmArray PP may still be useful at the early stage of pneumonia before culture and susceptibility test reports are available. Consequently, the results of FilmArray PP might alter the antibiotic prescription in 40.7% of the patients. Conclusions: FilmArray PP offers a rapid and sensitive diagnostic method for lower respiratory tract infections. However, clinical correlation is advised to determine its significance in interpreting multiple pathogens and detection of genes involved in antimicrobial resistance. ? 2019[SDGs]SDG3antibiotic agent; cefepime; cefotaxime; cefoxitin; ceftazidime; ertapenem; imipenem; meropenem; prescription drug; Acinetobacter calcoaceticus-baumannii complex; Adenoviridae; adult; aged; antibiotic resistance; antibiotic sensitivity; antibiotic therapy; Article; bacterium; bacterium culture; carbapenem resistance; cephalosporin resistance; Coronavirinae; critically ill patient; drug dose escalation; drug dose reduction; Enterobacter aerogenes; Enterobacter cloacae; Enterovirus; Escherichia coli; female; Haemophilus influenzae; health care quality; human; Human metapneumovirus; Human parainfluenza virus 2; Human rhinovirus; human tissue; infectious agent; Influenza A virus; intermethod comparison; Klebsiella oxytoca; Klebsiella pneumoniae; Legionella pneumophila; lower respiratory tract; lower respiratory tract infection; lung lavage; major clinical study; male; matrix assisted laser desorption ionization time of flight mass spectrometry; medical intensive care unit; microbial identification; middle aged; minimum inhibitory concentration; mixed infection; molecular diagnosis; multiplex polymerase chain reaction; nonhuman; penicillin resistance; pneumonia; prescription; Pseudomonas aeruginosa; quantitative analysis; Serratia marcescens; sputum culture; staging; Staphylococcus aureus; Streptococcus agalactiae; Streptococcus pneumoniae; tracheobronchial toilet; very elderly; virus; bronchoalveolar lavage fluid; comparative study; DNA microarray; genetics; intensive care unit; isolation and purification; microbiology; pneumonia; respiratory tract infection; sputum; virology; Adult; Aged; Aged, 80 and over; Bacteria; Bronchoalveolar Lavage Fluid; Female; Humans; Intensive Care Units; Male; Middle Aged; Multiplex Polymerase Chain Reaction; Oligonucleotide Array Sequence Analysis; Pneumonia; Respiratory Tract Infections; Sputum; Virusesjournal article10.1016/j.jmii.2019.10.009318065392-s2.0-85076233112