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Observational Study
. 2025 Jul 12;29(1):301.
doi: 10.1186/s13054-025-05503-7.

Assessing FilmArray Pneumonia+ panel dynamics during antibiotic treatment to predict clinical success in ICU patients with ventilated hospital-acquired pneumonia and ventilator-associated pneumonia: a multicenter prospective study

Julien Dessajan  1 , Michaël Thy  2   3 , Marc Doman  2 , Jules Stern  4 , Antoine Gallet  5 , Gaëlle Fouque  4 , Samuel Chosidow  5 , Stéphane Ruckly  6 , Signara Gueye  7 , Fariza Lamara  2 , Mariem Dlela  2 , Hermann Do Rego  2 , Michaël Ejzenberg  2 , Luc Haudebourg  2 , Julien Le Marec  2 , Cyril Potier  2 , Valentine Berti  3   7 , Nathalie Grall  3   7 , Stéphane Lo  3   7 , Naouale Maataoui  3   7 , Emilie Rondinaud  3   7 , Etienne Ruppé  3   7 , Frédéric Bert  8 , Véronique Leflon-Guibout  8 , Lila Bouadma  2   3 , Romain Sonneville  2   3 , Etienne de Montmollin  2   3 , Laurence Armand-Lefèvre  3   7 , Jean-François Timsit  2   3
Affiliations
Observational Study

Assessing FilmArray Pneumonia+ panel dynamics during antibiotic treatment to predict clinical success in ICU patients with ventilated hospital-acquired pneumonia and ventilator-associated pneumonia: a multicenter prospective study

Julien Dessajan et al. Crit Care. .

Abstract

Background: Accurate microbiological documentation seems central for managing severe pneumonia. While the FilmArray® Pneumonia + panel (FA-PP) offers rapid pathogen identification, its effectiveness during antibiotic treatment and in predicting clinical outcomes remains unclear.

Methods: We conducted a prospective observational study across four ICUs from April 2022 to June 2024, including patients with ventilator-associated pneumonia (VAP) or ventilated hospital-acquired pneumonia (vHAP). Bacterial loads were monitored on days 0, 1, 3, 7 and 10 and 3 days after stopping antibiotics, using endotracheal aspirates (ETAs) analyzed by FA-PP and standard cultures. The main objective was to assess the correlation between quantitative changes in FA-PP results and clinical success. Quantitative changes over time were analyzed using mixed ordinal logistic regression.

Results: Of the 93 patients enrolled, 60.2% (n = 56) achieved clinical success, while the ICU mortality rate was 25.8% (n = 24). Although FA-PP and culture quantification results declined over time (p < 0.0001), neither method consistently correlated with clinical success (non-significant for both). At diagnosis, FA-PP showed excellent diagnostic performance compared to culture, with a sensitivity of 94% [95% CI: 87-97] and a specificity of 98% [95% CI: 97-98]. Quantitative concordance improved with higher DNA copies, from 22.9% at the culture threshold at 10⁴ DNA copies/ml in FA-PP to 100% at ≥ 10⁷ DNA copies/ml. Diagnostic performance remained stable during antibiotic treatment with 94% sensitivity and 95% specificity in follow-up ETAs.

Conclusions: FA-PP provides rapid and accurate diagnostics, but repeated testing did not predict clinical outcomes during treatment, however our small sample size limited the study power.

Keywords: FilmArray pneumonia panel; Microbiological outcomes; Multiplex PCR; Nosocomial pneumonia; Ventilator-associated pneumonia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Société de Réanimation de Langue Française (SRLF) Ethics Committee on September 20, 2022 (No. 22–041). As this was an observational study, written consent was not required per national regulations. Since this study involved mechanically ventilated patients, participation was communicated to next of kin through an informative letter outlining their right to object. Upon discharge, patients received an informative letter, or it was mailed when necessary. Consent for publication: This study does not contain any individual person’s data in any form (such as images, videos, or personal details). Not applicable. Competing interests: JD, JFT, and LAL report the provision of mPCR kits free of charge to the study centers by BioMérieux. JD has received honoraria for lectures from BioMérieux. JFT has received consulting fees from Advanz, Menarini, Pfizer, and Merck, as well as honoraria for lectures from BioMérieux, Mundipharma, and Merck. LAL has received consulting fees from Shionogi and Viatris, honoraria for lectures from Advanz, Pfizer, and Shionogi, and has also given lectures without fees from BioMérieux and Qiagen. RS reports receiving grants from LFB and ABpharma outside the submitted work. HDR has received support for meetings from Shionogi. NG has received honoraria for lectures from Viatris and support for meetings from Pfizer. The authors declare no other financial or non-financial competing interests related to this study.

Figures

Fig. 1
Fig. 1
Waterfall plot of the greatest change in bacterial load from diagnosis (Day 0) to Day 3 in ICU patients with vHAP/VAP, and their corresponding clinical outcome. (A) Changes in DNA copies/ml quantified by FA-PP in 71 patients. (B) Changes in CFU/ml quantified by conventional culture in 58 patients. Data are derived from Table 2 . A Each patient is represented by a flow line according to the change in bacterial load from Day 0 to Day 3, classified into five categories: +2 log or more, + 1 log, no change, − 1 log, and − 2 log or less. The right column indicates the clinical outcome (success or failure). Bacterial load was assessed for the most abundant bacterium at Day 0. In cases of equal abundance, the most pathogenic was selected FA-PP FilmArray® Pneumonia + panel; CFU colony-forming unit
Fig. 2
Fig. 2
Proportion of bacteria detected at culture threshold categorized by FA-PP semi-quantitative results (DNA Copies/ml) for initial (Day 0) and follow-up samples. Culture diagnostic thresholds were defined as follows: BAL ≥ 104 CFU/ml, mini-BAL ≥ 103 CFU/ml, ETA ≥ 105 CFU/ml. For each FA-PP semi-quantitative category (DNA copies/ml), the proportion of bacteria detected at or above the culture threshold is shown by sample type and timepoint: Day 0 for BAL, mini-BAL, and ETA (A–D), and follow-up ETA (E) FA-PP FilmArray® Pneumonia+ panel, BAL bronchoalveolar lavage, CFU colony-forming unit, D0 Day 0
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References

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