Impact of FilmArray™ Respiratory Panel testing on the clinical management of pediatric bone marrow transplant patients

Mimi R Precit; Kaidi He; Kanokporn Mongkolrattanothai; Babak Moghimi; Marisa Glucoft; Jennifer Dien Bard

doi:10.1007/s10096-021-04382-4

Impact of FilmArray™ Respiratory Panel testing on the clinical management of pediatric bone marrow transplant patients

Eur J Clin Microbiol Infect Dis. 2022 Mar;41(3):395-405. doi: 10.1007/s10096-021-04382-4. Epub 2021 Nov 24.

Authors

Mimi R Precit^{1

2}, Kaidi He³, Kanokporn Mongkolrattanothai^{3

4}, Babak Moghimi^{4

5}, Marisa Glucoft⁶, Jennifer Dien Bard^{7

8

9}

Affiliations

¹ Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
² Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
³ Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
⁴ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁵ Department of Pediatrics, Division of Hematology and Oncology, Bone Marrow Transplant and Cell Therapy, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
⁶ Department of Quality Improvement & Patient Safety, Children's Hospital Los Angeles, Los Angeles, CA, USA.
⁷ Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, USA. jdienbard@chla.usc.edu.
⁸ Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. jdienbard@chla.usc.edu.
⁹ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. jdienbard@chla.usc.edu.

Abstract

Viral respiratory tract infections cause significant morbidity in bone marrow transplant (BMT) patients. Speed and sensitivity of the FilmArray™ Respiratory Panel (FA-RP) can improve care but may prompt inappropriate testing. Studies describing FA-RP use in pediatric BMT patients are limited; we investigated FA-RP use, results, and clinical management to evaluate clinical significance of testing in pediatric BMT patients. Retrospective analysis of 671 respiratory specimens from 204 unique BMT patients between 01/01/2016 and 01/01/2019 was performed. Age, underlying diagnoses, FA-RP result, reason for FA-RP, and symptoms were abstracted. FA-RP impact on antimicrobial management, scheduled procedures, infection control measures, and hospital admission/discharge were investigated. Impacts of repeat testing were evaluated. Two hundred sixty-nine out of 671 specimens (40%) tested positive; human rhinovirus/enterovirus (hRV/hEV) was the most common (161/269, 60%). The primary reason for FA-RP was URI symptoms (402/671, 60%) with 54% testing positive. One hundred twenty-two out of 671 (18.2%) specimens were from asymptomatic patients; 14 (11.4%) tested positive. FA-RP informed antiviral initiation in 7/19 (36.8%), 7/8 (87.5%), and 5/30 (16.7%) of RSV, influenza, and human parainfluenza cases, respectively. In 11 cases, FA-RP informed azithromycin and ceftriaxone initiation, continuation, or discontinuation. BMT was delayed for three positives (two RSV, one hRV/hEV). In 22 instances, negative FA-RP cleared patients for BMT. In 70% of cases, repeats offered no new clinical information; all negative-to-positive cases had new or worsening respiratory symptoms. FA-RP was ordered on symptomatic and asymptomatic patients, provided rapid diagnosis in > 50% of symptomatic patients, and informed infection control measures for all inpatients and antiviral initiation in > 80% of influenza cases.

Keywords: Bone marrow transplant patients; Pediatric infectious diseases; Pediatric respiratory viral infections; Syndromic testing.

MeSH terms

Bone Marrow Transplantation / adverse effects
Child
Humans
Infant
Respiratory System
Respiratory Tract Infections* / diagnosis
Respiratory Tract Infections* / drug therapy
Respiratory Tract Infections* / epidemiology
Retrospective Studies
Viruses*