Rapid multiplex PCR reduces pediatric antibiotic prescribing when paired with stewardship
Investigators evaluated the clinical impact of implementing the BIOFIRE FILMARRAY Pneumonia Panel alongside structured antimicrobial stewardship education at a Japanese tertiary pediatric center. In a pre-post cohort of 815 children with lower respiratory tract infections, the post-implementation period showed a significantly lower antimicrobial prescribing rate (adjusted odds ratio 0.39) and a marked reduction in broad-spectrum antibiotic days of therapy, while narrow-spectrum use remained stable. The study demonstrates that rapid multiplex PCR diagnostics can meaningfully support antimicrobial stewardship programs, provided clinicians are guided by clear decision algorithms. These findings highlight the laboratory's role in optimizing pediatric antimicrobial use through integrated diagnostic and educational workflows.
The original study
Clinical impact of the BIOFIRE FILMARRAY Pneumonia Panel combined with antimicrobial stewardship education on pediatric patients with lower respiratory tract infection: a pre-post study from a tertiary center in Nara, Japan.
- Authors
- Kitagawa D, Di Lorenzo A, Okamura T, Hachisuka S, Yamamoto N, Nishikawa H, et al.
- Journal
- Microbiology spectrum
- Type
- Journal Article
- PMID
- 42770765
Original abstract
UNLABELLED: Lower respiratory tract infections (LRTIs) account for a large share of pediatric antimicrobial prescriptions. The BIOFIRE FILMARRAY Pneumonia Panel (FAPN; BioMérieux) detects 33 respiratory pathogens within approximately 1 h. We investigated the clinical impact of its systematic introduction-combined with antimicrobial stewardship education. A retrospective cohort study was conducted at a tertiary pediatric center in Japan, enrolling all children aged <18 years with a lower respiratory tract infection between April 2023 and April 2026. In the post-FAPN period (April 2025-April 2026), the FAPN was implemented, alongside structured stewardship education incorporating a clinical decision flowchart. Logistic regression and generalized linear model (GLM) regression with log-link negative binomial distribution were employed for categorical and quantitative outcomes, respectively. Interrupted time-series analysis (ITSA) was performed using bimesters as time units and Newey-West standard errors. A total of 815 children were enrolled (pre-FAPN: 590; post-FAPN: 225). Antimicrobial prescribing rates were significantly lower following FAPN implementation (adjusted odds ratio, aOR: 0.39; 95% CI: 0.28-0.55; P < 0.001). Adjusted GLM regression identified a significant reduction in broad-spectrum antibiotic DOTs (adjusted β: -0.41; 95% CI: -0.66 to -0.05; P = 0.001), while narrow-spectrum antibiotic DOTs were unchanged. ITSA also confirmed a significant reduction in antimicrobial prescription rate (β: -0.53; 95% CI: -0.84 to -0.21; P = 0.001). The FAPN, combined with structured stewardship education, was significantly associated with reduced antimicrobial prescribing and a shift away from broader-spectrum antimicrobials. These findings support the clinical value of rapid multiplex PCR diagnostics in pediatric LRTIs when integrated with a strong antimicrobial stewardship program. IMPORTANCE: A strong stewardship education program may need to be combined with the introduction of a multiplex PCR test for pediatric pneumonia. With a clear decision flowchart, clinicians could successfully reduce antimicrobial use and shift their antimicrobial prescriptions to narrower ones.