Evaluation of the impact of BioFire FilmArray Blood Culture Panel 2 on diagnosis and treatment management in bacteremia patients

Objective: Early and appropriate empiric antimicrobial therapy in the management of sepsis and bacteremia is one of the most critical factors determining survival. However, the detection of pathogens and antimicrobial susceptibility using conventional blood culture, which is the reference method, can take 48–72 hours. The aim of this study is to evaluate the diagnostic performance and the clinical impact on treatment management of the multiplex PCR-based BioFire FilmArray Blood Culture Identification 2 (BCID2) panel, which provides results in approximately one hour directly from the blood culture bottle, in bacteremia patients with suspected sepsis. Materials and Methods: This retrospective, clinical impact, and method comparison study included 110 adult inpatients treated at Mengücek Gazi Training and Research Hospital between December 1, 2023, and September 20, 2024, who underwent BCID2 panel testing following a positive blood culture signal. Patients' clinical characteristics, microbiological culture data, phenotypic resistance results, and BCID2 panel findings were comparatively analyzed. The impact of the BCID2 panel's rapid pathogen and resistance detection capability on empiric antimicrobial treatment revisions at time T₀ was recorded, and a multivariate logistic regression analysis was performed to determine its independent effect on survival. Results: The mean age of the 110 patients included in the study was 66.4±15.8 years, and the in-hospital mortality rate was 56.4%. While conventional blood culture showed a positivity rate of 81.8%, the positivity rate with the molecular BCID2 panel was 91.8%. The target-based observed agreement between the two methods was 94.2%, and the patient-based correct identification rate was 93.6%. In the comparison of genotypic and phenotypic resistance, the phenotypic agreement of CTX-M positivity for extended-spectrum beta-lactamase (ESBL) was 94.5%, and the phenotypic agreement of OXA-48/NDM positivity for carbapenem resistance was 95.5%. Furthermore, the negative predictive value of 99.0% demonstrated that broad-spectrum therapies can be safely discontinued in the absence of a resistance gene. Based on the BCID2 results, empiric antibiotic therapy was optimized in 29.1% of cases within an average of 0.49 days. In the multivariate regression analysis, optimizing treatment at time T₀ was identified as an independent protective factor against in-hospital mortality (OR: 0.26, p=0.020). 14 Conclusion: Thanks to its high analytical sensitivity, the BCID2 panel can detect microorganisms even under antibiotic pressure and elucidates complex resistance profiles much faster than conventional culture. Early antibiotic optimization, enabled by pathogen and resistance gene identification within the first hour, has been shown to independently reduce mortality risk. The BCID2 panel should be integrated into routine sepsis management algorithms as a critical complementary tool rather than a replacement for conventional blood culture.