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. 2025 Jul 17;29(1):310.
doi: 10.1186/s13054-025-05528-y.

Diagnostic performance of Pneumonia multiplex PCR in critically ill immunocompromised patients

Jérémy Contier  1 , Laura Platon  1 , Nacim Benchabane  1 , Sonia Tchakerian  1 , Fanchon Herman  2 , Caroline Mollevi  2 , Patrice Ceballos  3 , Sylvain Godreuil  3   4 , Kada Klouche  5   6
Affiliations

Diagnostic performance of Pneumonia multiplex PCR in critically ill immunocompromised patients

Jérémy Contier et al. Crit Care. .

Abstract

Background: Admissions of immunocompromised patients to intensive care units (ICUs) are on the increase. The main reason for admission is acute respiratory failure, predominantly of infectious origin. In such circumstances, early and appropriate antibiotic therapy guarantees a better prognosis. Rapid diagnostic techniques such as multiplex polymerase chain reaction (PCR) have shown their value in both diagnosis and treatment in immunocompetent patients. To date, little data are available on immunocompromised patients.

Methods: In this retrospective, single-center study, we analyzed data from critically ill immunocompromised patients admitted for acute respiratory failure requiring invasive ventilation, in whom a respiratory specimen was taken and processed simultaneously by BioFire FilmArray Pneumonia Panel multiplex PCR (BFPPm PCR) and conventional culture (CC). Samples had to be taken from deep respiratory tracts less than 48 h after mechanical ventilation. The primary endpoint was the evaluation of the diagnostic performance of BFPP mPCR compared with CC. The secondary endpoint was the therapeutic impact of the results of BFPP mPCR.

Results: One hundred and fourteen patients were included, with immunosuppression mainly of a hematological (35.1%) and oncological (35.1%) nature. The mPCR positivity rate was 36.8%, with the majority identifying enterobacteria (51%) and a median turnaround time of between 2h30 and 4 h. Comparison of rapid techniques with CC showed sensitivity of 89%, specificity of 83%, predictive positive value of 52% and negative predictive value of 98%. Concordance between the two techniques was complete in 84.2% of cases. mPCR enabled antibiotic therapy to be modified in 17.5% of cases, mainly de-escalation.

Conclusion: The use of mPCR in the diagnosis of pneumonia in immunocompromised patients shortens the time required to obtain results, and is particularly effective in eliminating the presence of multi-resistant germs. Bacteria detected in culture and not included in the mPCR spectrum were mostly bacteria of low pathogenicity or sensitive to the antibiotics usually prescribed. The mPCR technique could reduce exposure to broad-spectrum antibiotics in this population.

Keywords: Acute respiratory failure; Antibiotic; Immunocompromised; Intensive care unit; Multiplex polymerase chain reaction; Pneumonia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The original study protocol was approved by the Institute Review Board of the Montpellier University Hospital (IRB-MTP_2023_09_20230143; dated 09/20/2023) and complied with French health authorities. An information note was given to each patient or their next of kin, and written informed consent of non-opposition was obtained from all patients or their proxies. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study population. ARF: acute respiratory failure; BFPP: BioFire® FilmArray® Pneumonia Panel; mPCR: multiplex polymerase chain reaction; ICU: intensive care unit; VAP: ventilation-acquired pneumonia
Fig. 2
Fig. 2
Incidence of bacteria detected by each of the 2 techniques BFPP mPCR: BioFire® FilmArray® Pneumonia Panel; CC: conventional culture; CNS: coagulase-negative Staphyloccocus; PCR: polymerase chain reactionaStreptococcusexceptS.pneumoniae, S.agalactiae and S.pyogenes
Fig. 3
Fig. 3
PCR and conventional culture results for BFPP panel bacteria. PCR: polymerase chain reaction; CC: conventional culture; TP: true positive; FP: false positive; FN: false negative; TN: true positive
See this image and copyright information in PMC

Comment in

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