Semi-Quantitative Detection of Respiratory Pathogens: A Systematic Review and Meta-Analysis of Results From the BIOFIRE FILMARRAY Pneumonia Panel and Culture

This systematic review and meta-analysis compared bacterial semi-quantification of respiratory samples from the BIOFIRE FILMARRAY Pneumonia (PN) Panels with quantitative and semi-quantitative culture methods (qCMs). Fourteen studies comprising 1,654 samples were included. Across both bronchoalveolar lavage-like and endotracheal aspirate-like specimens, the BIOFIRE PN Panel reported consistently higher bacterial loads than qCMs, with pooled mean differences of 1.17 and 0.95 log, respectively. Discrepancies decreased as culture-reported bacterial burden increased. The concordance rate in identifying the predominant pathogen was 94%, supporting the panel's clinical relevance. However, differential reporting at lower bacterial loads suggests that existing culture-based thresholds may not translate directly to molecular diagnostics. These findings highlight the need for pathogen- and method-specific interpretive thresholds to optimize the diagnostic utility of semi-quantitative molecular results and inform antimicrobial stewardship decisions.