The diagnostic performance of the BioFire® FilmArray® Pneumonia Panel Plus (FAPP) compared to standard microbial culture (SMC) during bronchiecta

Introduction: The clinical history is important before starting an antibiotic treatment to be able to predict the optimal duration of the therapy. We aimed to describe the clinical, analytical and microbiological characteristics of exacerbated patients with non-cystic fibrosis bronchiectasis (BE), in order to evaluate their association with the duration of antibiotic therapy. Methods: We performed a prospective bicentric study including adult patients with BE exacerbation divided into 2 groups according to the duration of antibiotic therapy (Group 1: less than or equal to 14 days, Group 2: from 15 to 21 days). A logistic regression analysis was performed to predict the long-term antibiotic treatment. Results: 191 patients were included (72[63;79] years); 108 (56.5%) females, 132 (69%) Group 1, 59(31%) Group 2. Cylindrical and cystic BQ (p=0.002), previous colonization of Pseudomonas aeruginosa (PA) (p=0.003), long-term oxygen therapy (LTOT) (p=0.001) and severe FACED scale (p=0.029) were associated with a long-term duration antibiotic therapy. PA (non-mucoid) was the most frequent microbiological isolation in group 2 (p=0.01) and Haemophilus influenzae in group 1 (p=0.03). In the multivariable logistic regression model; LTOT, intravenous and sequential intravenous to oral route of administration, and number of initial antibiotics ≥ 3 were identified for predicting the long-term duration of antibiotic therapy [AUC 0.74 (95% CI: 0.66-0.81)]. Conclusion: Some clinical findings could be useful for predicting the long-term duration of antibiotic therapy during an exacerbation of BE.

Background: Exacerbations are key determinants of disease progression and impaired health-related quality of life (HRQoL) in non-cystic fibrosis bronchiectasis (BE). Despite the recognised association between Pseudomonas aeruginosa (PA) and worse outcomes, factors driving exacerbation burden remain poorly characterised. In patients with PA-colonised BE, we aimed to assess whether microbiological factors, including colonisation status and PA phenotype, together with HRQoL domains and respiratory symptoms, were associated with time to first exacerbation, exacerbation severity, and post-exacerbation changes in HRQoL. Materials and Methods: This prospective longitudinal study followed PA-colonised BE adults for 12 months with quarterly stable-state assessments focussing on time and severity of first exacerbation. HRQoL was measured by the Quality of Life Questionnaire-Bronchiectasis (QOL-B). Multivariable Cox, Firth penalised logistic, and ANCOVA models were fitted in R. Results: A total of 68 patients were included. During follow-up, 52 patients (76.5%) experienced ≥1 exacerbation, including 14 (26.9%) whose first event required hospitalisation. Neither colonisation status nor PA phenotype were associated with exacerbation risk or hospitalisation. Better daytime cough (HR 0.63, 95%CI 0.41–0.97; p = 0.036) and dyspnoea while talking (HR 0.47, 95%CI 0.26–0.87; p = 0.016) were independently associated with lower exacerbation risk. Lower exertional dyspnoea burden (OR 0.29, 95%CI 0.10–0.67; p = 0.003) and lower sputum quantity (OR 0.46, 95%CI 0.19–0.93; p = 0.030) were associated with lower odds of hospitalisation, together with poorer Vitality, Social Functioning, and Health Perceptions. After exacerbation, Social Functioning declined significantly (Δ −7.50 points, 95%CI −14.87 to −0.14; p = 0.046) and mucoid PA was independently associated with worse Emotional Functioning (β −15.64, 95%CI −27.89 to −3.39; p = 0.013). Conclusions: In PA-colonised BE, selected respiratory symptoms and HRQoL domains were associated with exacerbation burden, whereas microbiological characteristics showed no clear associations with exacerbation risk or hospitalisation, supporting the incorporation of patient-reported outcomes into longitudinal assessment.

Introduction: The identification of the etiological agent of bronchiectasis exacerbations (BE) is primordial in order to administrate a proper treatment. Multiplex PCR panels, like BioFire® FilmArray Pneumonia panel (FAPN), are more rapid and sensitive compared to routine cultures in patients with community acquired pneumonia, but the evidence in BE is scarce. The aim of this study was to compare FAPN vs. conventional sputum culture results in patients with BE. Methods: We performed a prospective observational study including adult patients with BE at the Hospital Clinic of Barcelona. Sputum samples (1 per patient) were collected at the beginning of the BE(before antibiotic treatment) and processed for both microbiological studies(FAPN and conventional sputum culture). Results: 40 patients were included (67[18-86] years); 22(55%) females. Positive microbiological isolation was found in 15(38%) by conventional sputum culture vs 35(88%) by FAPN (Table 1). 30% of P. aeruginosa was underdiagnosed according to conventional sputum culture results. Therefore, the sensitivity of the FAPN method was 93%. Conclusion: Diagnosis using FAPN method allows obtaining quickly, safely and more sensitive results than conventional sputum culture in BE, especially P. aeruginosa. More studies are needed to find out if early detection improves the course of the disease.