Evaluation of a Commercial Multiplexed Molecular Lower Respiratory Panel at a Tertiary Care Cancer Center

• Published in: The Journal of molecular diagnostics : JMD Vol. 23; no. 12; pp. 1741 - 1748
• Main Authors: Cintrón, Melvilí, Sumner, Rawlica, McMillen, Tracy, Mead, Peter A., Babady, N. Esther
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2021; American Society for Investigative Pathology
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacteria - genetics; Bronchoalveolar Lavage Fluid - microbiology; Drug Resistance, Bacterial - genetics; Humans; Middle Aged; Multiplex Polymerase Chain Reaction - methods; Neoplasms - complications; Neoplasms - microbiology; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - microbiology; Regular; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - microbiology; Sensitivity and Specificity; Tertiary Care Centers
• ISSN: 1525-1578; 1943-7811
• DOI: 10.1016/j.jmoldx.2021.08.002

Diagnosis and management of bacterial pneumonia still relies on bacterial culture and antimicrobial susceptibility testing. The Unyvero Lower Respiratory Tract panel (LRT) is a multiplex molecular assay that provides results within approximately 4.5 hours. This study evaluated the analytical performance of the LRT on bronchoalveolar lavage (BAL) fluids and bronchial washings (BW) in a cancer patient population and retrospectively determined clinical impact on therapy. Sensitivity and specificity of LRT on BAL and BW compared with bacterial culture and susceptibilities were calculated. Chart reviews were performed to determine whether antibiotic management would have changed based on the LRT results. A total of 113 BAL and 123 BW respiratory samples from 191 patients were included. The overall sensitivity and specificity were 91.7% (95% CI, 77.5%-98.3%) and 92.0% (95% CI, 87.3%-95.4%), respectively. Staphylococcus aureus was the most common target detected (n = 21) with 89.5% (95% CI, 66.8%-98.7%) sensitivity and 98.2% (95% CI, 95.4%-99.5%) specificity. Based on availability of LRT results, 4.8% of patients could have been de-escalated faster. The LRT demonstrated an overall high accuracy for the detection of common bacteria associated with pneumonia. In this cancer inpatient cohort, treatment adjustment based on LRT results would have occurred in a small number of cases. Larger studies are necessary to understand the real-world impact within specific high-risk populations.