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The following is a summary of “Epidemiology and prediction of non-targeted bacteria by the filmarray pneumonia plus panel in culture-positive ventilator-associated pneumonia: a retrospective multicentre analysis,” published in the April 2025 issue of Annals of Intensive Care by Berteau et al. 

Researchers conducted a retrospective study to evaluate the potential of multiplex PCR (mPCR) for personalized empirical treatment and optimization of antibiotic therapy in ventilator-associated pneumonia (VAP).  

They analyzed culture-positive VAP cases from January 2016 to March 2021 across 12 intensive care units (ICUs) in France. The prevalence of non-targeted bacteria was evaluated based on bacterial species included in the BioFire ^®  FilmArray ^®  Pneumonia Panel (FAPPP). Associated risk factors were identified. Non-targeted bacteria were defined as bacterial species isolated during VAP and not included in the FilmArray panel but considered by clinicians in the final antibiotic therapy.  

The results showed that among 332 patients with 385 culture-positive VAP episodes, non-targeted pathogens were found in 23% of cases (87/385) and represented 21% (110/534) of isolated bacteria (excluding bacteria with low pathogenicity, the rate of VAP with non-targeted bacteria was 21%). The most common non-targeted bacteria identified were Stenotrophomonas maltophilia (22%), Citrobacter koseri, and Hafnia alvei. Gram stain results had a poor correlation with definitive cultures (42% concordance). The proportion of culture-positive VAP with non-targeted bacteria varied significantly across ICUs, ranging from 12% to 37% (P = 0.013). Polymicrobial culture-positive VAP had a 2-fold higher risk of non-targeted bacteria (47% vs 25%, P< 0.001). Multivariate analysis showed that in-ICU antibiotic exposure was associated with a 2-fold increased risk of non-targeted bacteria (25.3% vs 12.9%, P= 0.042), and age over 70 years was associated with a 3-fold increased risk (P= 0.027). Among 48 culture-positive VAP cases with ineffective empiric treatment, Pseudomonas aeruginosa (22%), Stenotrophomonas maltophilia (14%), and Enterobacter cloacae complex (8%) were the most frequent bacteria. Additionally, 67% of culture-positive VAP cases with ineffective empirical therapy involved targeted bacteria, with 59% potentially benefiting from effective empirical therapy if panel results had been available based on bacterial species identification and current guidelines.  

Investigators concluded that the considerable occurrence of culture-positive VAP with non-targeted bacteria in the study suggested potential issues in interpreting FAPPP outcomes, and only positive FAPPP findings might aid clinicians in the timely individualization of antibiotic treatment for VAP. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01468-6