BioFire FilmArray BCID2 versus VITEK-2 System in Determining Microbial Etiology and Antibiotic-Resistant Genes of Pathogens Recovered from Central Line-Associated Bloodstream Infections

SIMPLE SUMMARY: Central line-associated bloodstream infection (CLABSI) is among the most serious hospital-acquired infections that impose public health threats. Accordingly, the urgent need for a rapid identification method that can identify CLABSI pathogens and their resistance genetic markers is essential for the prompt initiation of adequate antibiotic therapy. This study aimed to evaluate the clinical performance of the BioFire FilmArray Blood Culture Identification 2 (BCID2) panel in the rapid identification of 33 microbial species and 10 antibiotic resistance genes in comparison to the VITEK-2 system, among 104 patients admitted to an ICU in an Egyptian tertiary care hospital with bloodstream infections (BSIs) within 48 h of a central line placement. In comparison to the VITEK-2 system, the BCID2 panel showed an overall sensitivity of 75.8% and an overall specificity of 98% in detecting microbial species. The sensitivity and specificity for detecting resistance genes by BCID2 were 90% and 99.6%, respectively. In conclusion, this study emphasizes the high sensitivity and specificity of the BCID2 as compared to the VITEK-2 system in the rapid and reliable microbial identification, as well as the accurate detection of various antibiotic resistance markers. ABSTRACT: Central line-associated bloodstream infection (CLABSI) is among the most serious hospital acquired infections. Therefore, the rapid detection of the causative microorganism is of crucial importance to allow for the appropriate antimicrobial therapy. In the present study, we analyzed the clinical performance of the BioFire FilmArray Blood Culture Identification 2 (BCID2) panel in the identification of 33 microbial species and 10 antibiotic resistance genes in comparison to the VITEK-2 system. A total of 104 blood specimens were included. The FilmArray BCID2 results were concordant with the VITEK-2 system in 69/97 specimens (71.1%). Non-concordance was either due to the detection of more pathogens by the FilmArray BCID2 23/28 (82%) or microbial species were misidentified 5/28 (18%). Hence, in comparison to the VITEK-2 system, the FilmArray BCID2 panel showed an overall sensitivity of 75.8% (95% CI, 66–83%) and an overall specificity of 98% (95% CI, 97–98.8%) in detecting microbial species. For the resistance genes, the FilmArray BCID was able to detect the presence of blaCTX-M gene in 23 Gram-negative isolates, blaNDM and blaOXA-48- like genes in 14 and 13 isolates, respectively. The mecA and mecC genes were found in 23 Staphylococcus species, while mecA, mecC and MREJ genes were found in 4 Staphylococcus aureus isolates. The sensitivity and specificity for detecting resistance genes by the FilmArray BCID2 was 90% (95% CI, 81.4–95%) and 99.6% (95% CI, 99–100%), respectively. As concluded, the present study emphasizes the high sensitivity and specificity of the FilmArray BCID2 in the rapid and reliable detection of different bacteria and fungi from positive blood culture bottles, as well as the accurate detection of various antibiotic resistance markers.