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This study evaluates the significance of negative BioFire results in ICU patients suspected of having pneumonia and their impact on clinical management.

April 1, 2026International Journal of Infectious Diseases0 citationsOpen Access

Clinical significance of negative BioFire® Pneumonia Panel in ICU: diagnosis, management, and outcomes

TNThibault NardyUniversité Claude Bernard Lyon 1 EREmilie RondinaudUniversité Claude Bernard Lyon 1 JDJulien DessajanUniversité Claude Bernard Lyon 1

Key Points

This study evaluates the significance of negative BioFire results in ICU patients suspected of having pneumonia and their impact on clinical management.
Conducted a retrospective analysis from April 2021 to July 2023.
Included 190 ICU patients with negative BioFire Pneumonia Panel results on respiratory samples.
Compared patients with microbiologically confirmed pneumonia to those without.
36% of patients had culture-confirmed pneumonia.
Gram-negative bacilli on Gram stain significantly predicted true infection.
The false-negative rate for detected bacteria was 12%.
Recent antibiotic exposure decreased the likelihood of confirmed infection.
Some non-infected patients had antibiotics withdrawn based solely on negative BioFire results.

Abstract

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.

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