Conventional blood culture remains the diagnostic gold standard for bloodstream infection, but its prolonged turnaround time—incubation followed by phenotypic testing—can delay appropriate antimicrobial therapy. The authors evaluated the impact of implementing the multiplex PCR BIOFIRE Blood Culture Identification 2 (BCID2) panel as a rapid diagnostic test in hospitalized pediatric patients.
This investigation used a case-control cohort design comparing 150 retrospective (pre-BCID2) cases with 150 prospective cases in which positive blood cultures were evaluated in parallel by BCID2 and conventional culture. The local antimicrobial stewardship program (ASP) team provided antimicrobial recommendations based on BCID2 findings; final treatment decisions were left to the attending physicians. Time to targeted therapy was measured from the initial antibiotic dose (or from blood culture collection if the patient was already receiving antibiotics) to the start of targeted antimicrobial therapy.
The median age of patients in the BCID2 cohort was 2.8 years versus 1.7 years in the pre-BCID2 cohort; this difference reached statistical significance (P = 0.032). Regarding diagnostic coverage, 18 of 150 BCID2 cases (12%) were not identified by the panel because the causative organisms were off-panel targets. These off-panel detections therefore limited the immediate actionable results from BCID2 in a subset of patients.
Excluding the 18 off-panel cases, BCID2 results prompted a change in antimicrobial therapy in 38 of 132 cases, representing 28.8% of interpretable BCID2 results. The study paired BCID2 reporting with active ASP involvement; the ASP provided recommendations informed by rapid PCR findings while the attending clinicians made final prescribing decisions. The authors conclude that BCID2 implementation together with stewardship optimized antimicrobial use in pediatric bacteremia by enabling earlier targeted therapy.
The report also states that integration of rapid diagnostic testing into an ASP was associated with reductions in both 30-day mortality and hospital length of stay; the source describes these associations qualitatively but does not report numerical values for mortality or length-of-stay reductions in the abstract.
Time to targeted therapy was a prespecified outcome. Median time to targeted antimicrobial therapy was shorter in the BCID2 group at 17.0 hours (IQR 9.6–34.2) compared with 24.2 hours (IQR 16.3–52.2) in the conventional culture group. This difference was statistically significant (P = 0.014), indicating that multiplex PCR-based identification facilitated earlier initiation of targeted agents in this pediatric cohort.
Using multivariable logistic regression, the authors found that the BCID2 intervention remained an independent and significant predictor of achieving rapid antimicrobial optimization. The adjusted odds ratio was 2.68 (95% CI 1.17–6.14; P = 0.019), showing that patients evaluated with BCID2 had increased odds of timely antimicrobial modification compared with the pre-implementation group after adjustment for other factors included in the model.
The study supports the clinical value of incorporating rapid diagnostic testing such as the BIOFIRE BCID2 panel into routine management of pediatric bloodstream infection, particularly when linked to an active antimicrobial stewardship program that can translate rapid results into treatment recommendations. In this cohort, BCID2 shortened median time to targeted therapy and drove antimicrobial changes in nearly 29% of interpretable cases.
However, the authors highlight important limitations: the BCID2 panel does not detect all possible bloodstream pathogens, as evidenced by 12% off-panel cases in this cohort, and rare genotype-phenotype discrepancies can occur. Thus, a negative or non-identifying BCID2 result requires careful clinical interpretation and confirmation by conventional culture when indicated.
Finally, while the abstract reports that RDT integration with stewardship was associated with reduced 30-day mortality and shorter hospital length of stay, the source does not provide quantitative outcome data for those endpoints in the abstract. Those details would require review of the full text for precise figures and additional context.
Overall, the reported findings support use of the BIOFIRE BCID2 panel as a tool to accelerate pathogen identification and antimicrobial optimization in pediatric bacteremia when combined with stewardship resources, while reminding clinicians to recognize the panel’s coverage limits and to interpret negative results with clinical judgement.