ObjectivesThis study assessed the clinical significance of negative BioFire FilmArray Pneumonia Panel (FA-PP) results in ICU patients with suspected hospital-acquired (HAP) or ventilatorassociated pneumonia (VAP), evaluating its impact on diagnosis, antimicrobial management, and outcomes, and identifying factors associated with false-negative results. MethodsA retrospective single-center study (April 2021-July 2023) included 190 critically ill patients with negative FA-PP results on deep respiratory samples.Patients with microbiologically confirmed HAP/VAP were compared to those without. ResultsAmong 190 patients, 69 (36%) had culture-confirmed HAP/VAP.Gram-negative bacilli (GNB) on Gram stain independently predicted true infection (OR=3.08,95% CI 1.47-6.45,p=0.003).The false-negative rate for FA-PP-detectable bacteria was 12% (31/251), mainly Klebsiella pneumoniae and Pseudomonas aeruginosa.Non-targeted GNBs accounted for 27% (19/69) of confirmed cases.Recent broad-spectrum antibiotic exposure (3 months) reduced confirmed infection likelihood (OR=0.28,95% CI 0.13-0.6,p<0.001).No inappropriate antibiotic de-escalation occurred, but 6% (7/121) of non-infected patients had antibiotics withdrawn based solely on FA-PP negativity. ConclusionsNegative FA-PP results do not exclude HAP/VAP, especially with non-targeted GNBs or recent antibiotic exposure.Gram stain remains a valuable complementary tool.Integrated diagnostic approaches are essential for optimal antimicrobial stewardship in ICU settings.
Nardy et al. (Sun,) studied this question.