How does the comprehensive, syndromic approach of the BioFire BCID Panel over a Gram stain-directed approach impact clinical operations?
As a clinician doing antimicrobial stewardship and patient care, you start to develop a healthy appreciation that Gram stains are helpful, but they’re not foolproof. There’s a lot of variability when you do repeat Gram stains. It’s an art, and with that, if you have direct detection of genes and organisms, it doesn’t really make sense to direct your panel based off of a Gram stain.
It’s not just a conceptual thing. We’ve actually seen this. During my residency training, I ran across this within a week of starting with the BioFire product. We only saw gram-positive cocci in clusters on the Gram stain, but the BioFire BCID Panel detected six organisms and multiple resistance mechanisms. This was a cystic fibrosis patient that had a central line, was in the ICU and was very sick, and we were able to really streamline their therapy because of what the panel found.
Then using the panel as a guide for a second review of the Gram stain with high-power fields, we were actually able to see yeast elements and gram-positive cocci in chains. With further workup of that culture, we were able to isolate all of those organisms and phenotypically confirm the resistance markers that we saw on the BioFire BCID Panel as well. That really speaks to the fact that Gram stain-directed approaches for syndromic assays for bloodstream infections aren’t really optimal, because you’ll have situations with critically ill patients where you do inappropriate therapy for an extended period of time, probably 48 hours, before you actually find out that you made the wrong decision based off of a Gram stain. These technologies are game changers.