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June 14, 2026Clinical Infectious Diseases1 citations

Clinical Impact of the BIOFIRE® FILMARRAY® Pneumonia Panel in the Veterans Affairs Healthcare System: A Difference-in-Differences Study

NBNicholas Britt KKKarim Khader THTao He

Key Points

This research aims to evaluate the clinical impact of the BIOFIRE® FILMARRAY® Pneumonia Panel on antibiotic optimization in ICU patients.
National, multicenter retrospective study of ICU pneumonia patients across Veterans Health Administration hospitals.
Comparison of intervention sites using the BIOFIRE® PN Panel and matched control facilities without implementation.
Outcomes analyzed through a difference-in-differences framework with inverse probability weighting to adjust for baseline imbalances.
BIOFIRE® PN Panel implementation was linked to increased early antimicrobial de-escalation (adjusted RR 1.14; 95% CI, 1.04-1.26).
In culture-positive patients, early antimicrobial de-escalation increased (aRR 1.23; 95% CI, 1.02-1.50) and early appropriate therapy was also improved (aRR 1.11; 95% CI, 1.04-1.18).
ICU mortality was significantly lower among culture-positive patients post-implementation (aRR 0.70; 95% CI, 0.50-0.97).

Abstract

BACKGROUND: Rapid diagnostics such as the BIOFIRE® FILMARRAY® Pneumonia (PN) Panel may enhance antibiotic optimization, yet real-world evidence remains limited, and few studies have assessed how differences in institutional antimicrobial stewardship (ASP) capacity influence clinical outcomes. METHODS: We conducted a national, multicenter retrospective study of ICU patients with pneumonia admitted to Veterans Health Administration hospitals. Hospitals that implemented the PN Panel for ≥6 months served as intervention sites, while matched facilities without implementation served as controls. Outcomes were assessed using a difference-in-differences framework with inverse probability weighting to account for baseline imbalances and secular trends, including those related to the COVID-19 pandemic. Co-primary outcomes, assessed following index culture collection, were early antimicrobial de-escalation (24-48 hours) and early appropriate therapy (0-24 hours); secondary outcomes were 30-day and ICU mortality. RESULTS: The study included 11 746 patients, including 4523 from hospitals that implemented the BIOFIRE® PN Panel and 7223 from matched control hospitals. Overall, PN implementation was associated with early antimicrobial de-escalation (adjusted RR aRR, 1.14; 95% CI, 1.04-1.26). Among culture-positive patients, PN Panel implementation was significantly associated with early antimicrobial de-escalation (aRR, 1.23; 95% CI, 1.02-1.50) and early appropriate therapy (aRR, 1.11; 95% CI, 1.04-1.18). Overall ICU and 30-day mortality did not differ, though ICU mortality among culture-positive patients was relatively lower following PN Panel implementation (aRR, .70; 95% CI, 0.50-0.97). Improvements in antimicrobial optimization were most evident in hospitals with greater ASP capacity. CONCLUSIONS: BIOFIRE® PN Panel implementation improved antibiotic optimization in critically ill pneumonia patients, with the greatest gains seen in hospitals with comprehensive ASP programs.

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Britt et al. (Fri,) studied this question.

synapsesocial.com/papers/6a2e4429b1cc60ccdea89f97 https://doi.org/https://doi.org/10.1093/cid/ciag328

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