Search Results (76)

Background: Candidemia carries case-fatality rates exceeding 30% in pediatric oncology cohorts from low- and middle-income countries. We describe a temporal cluster of culture-confirmed candidemia cases at King Hussein Cancer Center (KHCC), Amman, Jordan, coinciding with a novel environmental event and the multidisciplinary infection prevention and control (IPC) response undertaken. Methods: This retrospective cohort study describes seven pediatric inpatients with culture-confirmed candidemia identified between June 1 and September 30, 2025, at a 330-bed tertiary oncology center against a background rate of one confirmed case in the preceding six months. An additional five patients with clinically suspected invasive fungal infection (IFI) but negative blood cultures are described separately. Species identification was performed using the BioFire FilmArray Blood Culture Identification (BCID) panel (multiplex PCR); MALDI-TOF MS was additionally available; antifungal susceptibility was determined using the Sensititre system (Thermo Fisher Scientific, UK). Results: The seven confirmed cases comprised six males and one female (median age: 12 years; range: 1–17 years). Underlying diagnoses were predominantly leukemia (71%). All patients had a central venous catheter (CVC) in situ and recent broad-spectrum antibiotic exposure. Candida tropicalis was the predominant species (57%), with azole resistance identified in 42% of tested isolates. A plumbing infrastructure failure with an associated water leak was identified in late August 2025 during the cluster investigation; structural repair was completed in September 2025. The last confirmed case was recorded on 23 September 2025. All patients received guideline-concordant echinocandin- or amphotericin-based therapy. Candidemia-attributable mortality was 14% (1/7). Conclusions: A temporal cluster of seven culture-confirmed candidemia cases—representing a 7-fold increase above background incidence—was identified at a Jordanian pediatric oncology center. The cluster coincided with a documented environmental water leak. Individual single-room isolation, geographic ward sectioning, contact precautions, hand hygiene monitoring, expanded antifungal prophylaxis with real-time protocol adjustment, and environmental remediation were all implemented and documented with defined operational criteria. These data demonstrate that a structured, criteria-driven IPC bundle is operationally feasible at a resource-limited tertiary oncology center. Full article

Syndromic multiplex-PCR panels deliver rapid, comprehensive detection of pathogens and resistance determinants in acute infections, but their unrestricted use can generate a high proportion of negative results with substantial economic and stewardship implications. We retrospectively analysed all BioFire FilmArray meningitis/encephalitis (ME), upper-respiratory (RP2.1), pneumonia (PN) and gastrointestinal (GI) determinations performed at the UOSD Microbiology and Virology of P.O. “Vito Fazzi”, ASL Lecce (Apulia, Italy) between 1 July 2024 and 30 April 2026. Repeat determinations from the same patient with the same panel were identified in the laboratory information system and removed before any analysis, so that each determination analysed corresponds to a distinct diagnostic episode. Across 5381 determinations (CNS, n = 761; upper respiratory, n = 2601; lower respiratory, n = 399; gastrointestinal, n = 1620), 59.3% were negative for every target, with a steep appropriateness gradient: 90.0% negativity for the ME panel and 77.1% for the gastrointestinal panel versus 44.2% for the upper-respiratory and 26.6% for the pneumonia panel. CNS positives were predominantly viral (75%), led by enterovirus; Streptococcus pneumoniae was the only consistent bacterial agent. Human rhinovirus/enterovirus dominated the respiratory ecology; influenza A was almost entirely H3 and H1N1pdm09, but 8.1% of influenza-A–positive specimens were equivocal or non-subtypeable and were never referred for sequencing, an avoidable surveillance blind spot for novel/zoonotic (avian) influenza. Pneumonia-panel resistance markers (mecA/C–MREJ, CTX-M, KPC, NDM) clustered in Enterobacterales co-infections. The gastrointestinal panel was dominated by diarrhoeagenic Escherichia coli pathotypes (chiefly EPEC and EAEC) and Clostridioides difficile toxin, its 77% negativity identifying a second over-utilised stream. We argue for CSF-pleocytosis gating, tiered/reflex respiratory algorithms, gastrointestinal-panel gating to community-onset diarrhoea, and mandatory reflex sequencing of unsubtypeable influenza A. Full article

Background/Objectives: Bloodstream infections (BSIs) carry high mortality, and any delay in initiating optimal antimicrobial therapy worsens outcomes. Syndromic multiplex-PCR panels applied to signal-positive blood cultures markedly shorten time-to-identification but are expensive and report results in a strictly qualitative format. We describe twenty-two months of real-world BioFire FilmArray Blood Culture Identification 2 (BCID2) testing in a southern Italian hospital, focusing on pathogen epidemiology, resistance-gene detection, and the economic and interpretive trade-offs of the assay. Methods: We retrospectively reviewed all BCID2 runs performed on signal-positive blood-culture bottles at P.O. “Vito Fazzi” (ASL Lecce) from July 2024 to April 2026. Each run was classified as single-pathogen-positive, polymicrobial (co-infection)-positive, or negative (no on-panel target). Resistance determinants were tabulated by year and by presumptive carrier. A direct-cost analysis was performed at a reagent cost of €250 per test. Results: Of 498 runs, 401 (80.5%) yielded at least one on-panel target (330 single-pathogen, 71 polymicrobial), whereas 97 (19.5%) were negative. Among 526 organism detections, Gram-positive (48.9%) and Gram-negative (45.8%) bacteria predominated; Staphylococcus spp., Escherichia coli and the Klebsiella pneumoniae group were most frequent. Resistance determinants (n = 244) were dominated by mecA/C, CTX-M and KPC. Co-infections (17.7% of positives) frequently prevented unambiguous attribution of a resistance gene to a specific co-detected organism. Total reagent expenditure was €124,500, of which €24,250 (19.5%) was spent on negative results. Conclusions: BCID2 delivered rapid, broad pathogen and resistance-gene detection in a high-resistance setting. Its qualitative-only output, the difficulty of attributing a resistance gene to a specific organism in polymicrobial samples, and the cost of negative results nonetheless argue for diagnostic-stewardship gating, semiquantitative reporting, and local validation of complementary and lower-cost assays. Full article

Meningitis multiplex PCR (MMP) panels are increasingly used in acute bacterial meningitis (ABM), but their clinical integration remains incompletely characterized. We evaluated MMP panel implementation using a mixed-methods approach. We included 55 adults with ABM of confirmed etiology: Group 1 (MMP plus conventional microbiology, n = 25) and Group 2 (conventional methods only, n = 30). The qualitative component comprised semi-structured interviews with infectious disease specialists, analyzed using thematic analysis. Compared with Group 2, Group 1 had a significantly shorter time from lumbar puncture to diagnosis [1.9 (IQR 1.7–2.6) vs. 27.3 (18–47.2) h] and more frequent targeted therapy [19 (76%) vs. 13 (43.3%)]. However, MMP panel use was not associated with antibiotic de-escalation [11 (44%) vs. 12 (40%)], median length of hospitalization (22 days in both groups), median duration of therapy [14 (10–21) vs. 17 (11–22) days], ICU admission [11 (44%) vs. 13 (43.3%)], or mortality [2 (8%) vs. 6 (20%)]. Interviews (n = 20) identified four themes: rapid etiological clarification, perceived limitations, antimicrobial optimization and clinical integration. MMP may facilitate rapid diagnosis, but its impact on outcomes and clinical integration remains limited. Faster availability of etiological information does not necessarily improve antimicrobial decision-making in the absence of antimicrobial stewardship programs. Full article

Background: Respiratory infections in critically ill patients remain a major challenge in intensive care units (ICUs), with high morbidity and mortality. Conventional microbiological methods often fail to identify the causative pathogen promptly, particularly in patients previously exposed to antibiotics. Multiplex molecular platforms, such as the BioFire FilmArray^® Pneumonia Panel Plus (FAPP), allow rapid detection of multiple respiratory pathogens and resistance markers, potentially improving early therapeutic decision-making. The objective of this work is to evaluate the impact of implementing FAPP on antimicrobial therapeutic decisions in critically ill patients with suspected respiratory infection. Methods: We conducted a retrospective cohort study in two mixed ICUs between 2023 and 2024. All respiratory samples in which FAPP was requested were analyzed. The results were compared with conventional cultures, and changes in antimicrobial therapy following the FAPP results were assessed, classified as escalation/initiation or de-escalation/discontinuation. Concordance between FAPP and culture was evaluated, and clinical and demographic variables were analyzed. Differences between groups were assessed using p-values obtained from the chi-square test or the Mann–Whitney test. Results: A total of 363 respiratory samples were included, 88.4% from mechanically ventilated patients. FAPP was positive in 65.3% of samples, whereas cultures were positive in 23.1%. Overall concordance between FAPP and culture was 57.3%. In 42.4% of cases, pathogens were detected exclusively by FAPP. Antimicrobial therapy was modified in 29.8% of patients, predominantly through de-escalation or discontinuation (69.4% of changes). Therapeutic modifications were more frequent in nosocomial infections and in patients with a positive FAPP result. Conclusions: The use of FAPP in critically ill patients with suspected respiratory infection provides rapid microbiological information that significantly influences antimicrobial decision-making, particularly by facilitating antibiotic de-escalation. Although discrepancies with conventional cultures remain and require careful clinical interpretation, FAPP represents a valuable tool for antimicrobial stewardship in the ICU setting. Full article

Background: Rapid etiological diagnosis of bacterial meningitis is crucial in children, as delays can lead to neurological sequelae. The BioFire FilmArray Meningitis/Encephalitis (ME) panel is widely used on cerebrospinal fluid (CSF), but its target spectrum may miss healthcare-associated or multidrug-resistant pathogens. We evaluated the diagnostic performance and stewardship-oriented clinical impact of off-label BioFire FilmArray Blood Culture Identification 2 (BCID2) testing on CSF from pediatric patients with suspected bacterial CNS infection and negative ME results. Methods: We retrospectively analyzed CSF samples collected between January 2023 and March 2025 at a tertiary pediatric hospital. In ME-negative cases with persistent suspicion and abnormal CSF parameters, BCID2 was performed off-label on residual CSF aliquots after routine testing, without additional sampling. We assessed pathogen detection, agreement with culture, resistance-gene identification, and documented stewardship actions. Results: Among 76 ME-negative CSF samples tested with BCID2, 23 (30.3%) were positive, all involving organisms not included in the ME panel. BCID2 was concordant with culture in 19/23 cases (82.6%); 4/23 (17.4%) were BCID2-positive/culture-negative, consistent with reduced culture sensitivity in frequently pretreated cases. Resistance genes (VIM, vanA/B, CTX-M) were detected in 30.4% of BCID2-positive samples. Overall agreement with culture was 94.7% (PPA 100%, NPA 93.0%). Escalation was documented in 13/23 episodes (56.5%), discontinuation in 2/23 (8.7%), and confirmation in 9/23 (39.1%), with no de-escalation events; clinical outcomes were not systematically available. Conclusions: In selected ME-negative pediatric cases with abnormal CSF profiles, BCID2 testing on residual CSF provided rapid, clinically meaningful microbiological information that may support antimicrobial optimization. Full article

Respiratory syncytial virus (RSV) imposes a substantial burden of severe acute respiratory infection (SARI), especially in young children and the elderly. Methods: We describe RSV epidemiology among hospitalized SARI patients at the Ibn Sina University Hospital Center (Rabat, Morocco) from 1 January 2021, to 31 December 2025, using multiplex PCR (BioFire^® RP2.1plus or Xpert^® SARS-CoV-2/Flu/RSV). Results: Among 4604SARI samples, RSV prevalence was 16.1% (739/4604), predominantly pediatric (88.6%, p < 0.001), with peak burden in infants <6 months (70.4% of cases, p < 0.001). Pediatric prevalence was 28.3% (655/2316) vs. 3.8% (84/2204) in adults (p < 0.001), with predominance in the elderly ≥60 years (51/1041, 4.9%). Co-infections occurred in 46.7% (310/665) of FilmArray-tested positives (total = 665), led by rhinovirus/enterovirus (198/310, 63.9%), and were significantly higher in children (48.5%, p < 0.001). RSV peaked in winter (51.6%), except for summer dominance in 2021 (52.5%), reflecting COVID-19 non-pharmaceutical intervention effects. Conclusions: These data establish Morocco’s first comprehensive RSV surveillance baseline, highlighting post-pandemic epidemiological shifts. As maternal vaccines and monoclonal antibodies emerge, these data inform optimal implementation in low- and middle-income countries (LMICs). Full article

Background: Molecular syndromic stool panels are increasingly used in paediatric diarrheal syndromes; however, interpretation of Clostridioides difficile (C. difficile) detection remains challenging because colonisation is common in younger children. We aimed to assess the frequency of C. difficile detection using a syndromic gastrointestinal panel in a paediatric tertiary-care centre and to describe the subsequent microbiological work-up and CDI-directed treatment. Methods: We conducted a retrospective single-centre study of all BioFire FilmArray Gastrointestinal (GI) panels performed at San Marco Hospital (University Hospital “G. Rodolico-San Marco”, Catania, Italy) from 1 January 2023 to 31 December 2025. Only the first C. difficile-positive result per patient was included; repeat positives within 30 days were excluded. Index-positive episodes were stratified by age (<1 year, 1 to <2 years, and ≥2 years). Data collected included co-detected pathogens, toxin A/B enzyme immunoassay (EIA) results, GeneXpert PCR findings, and CDI-directed therapy. Results: Among the 714 GI panels performed during the study period, 112 (15.7%) were positive for C. difficile. After exclusion of repeat positives, 91 index-positive episodes were analysed. Median age was 1.0 years (IQR 0.75–4.0), and 48/91 cases (52.7%) occurred in children younger than two years. Toxin A/B EIA was positive in 11/82 tested episodes (13.4%), whereas GeneXpert tcdB was positive in 75/84 episodes (89.3%). Co-detection of at least one additional enteric pathogen occurred in 40/91 cases (44.0%). CDI-directed therapy was administered in 9/91 episodes (9.9%), mainly in children aged ≥2 years. Conclusions: Detection of C. difficile by syndromic molecular panels was relatively frequent in our paediatric cohort but rarely associated with toxin positivity or the need for specific treatment. These findings suggest that many positive Nucleic Acid Amplification Test (NAAT) results may represent colonisation rather than true infection, particularly in younger children. Careful clinical interpretation of syndromic panel results is therefore essential to avoid overdiagnosis and unnecessary antimicrobial therapy. Full article

Background: Syndromic testing panels, such as the BioFire FilmArray^® Meningitis/Encephalitis (M/E) panel, have become essential in altering the way that central nervous system diseases are diagnosed in the rapidly changing fields of molecular diagnostics, infectious diseases, and neurology. Long turnaround times, minimal pathogen output, and the requirement for live organisms are some of the common limitations of traditional cerebrospinal fluid culture techniques. A potential addition to traditional diagnostics is the FilmArray^® M/E panel, which uses multiplex polymerase chain reactions to identify many diseases quickly and simultaneously in a very short time, which affects multiple outcomes for the patient. Aims: Despite the M/E panel’s considerable speed and detection benefits, there are some issues related to cost, erroneous findings, and contextual interpretation. Methods: This narrative review highlights fundamental research and meta-analyses that have studied the FilmArray^® M/E panel’s practical performance while comparing its diagnostic accuracy, clinical impact, and cost-effectiveness with the CSF culture. The latter occurs across different demographics and contexts. Results: Different studies have demonstrated that the M/E panel significantly shortens hospital stays, decreases unnecessary antibiotic usage, and speeds up the diagnosis of meningitis or encephalitis. Nonetheless, the necessity for cautious diagnostic management and supplementary testing strategies is underlined as there exist variations in sensitivity and specificity across pathogens, especially in viral ones. By facilitating quick, focused, and data-driven treatment for patients, the BioFire FilmArray^® M/E panel provides an advancement in meningitis and encephalitis diagnostics, which is consistent with the concept of precision medicine. Conclusions: To adequately guarantee fair and efficient results, its best application into clinical practice requires integration with clinical judgment, conventional culture techniques, and economic optimization strategies. Full article

Background/Objectives: Rapid pathogen identification is essential to optimize antimicrobial therapy and improve patient outcomes, particularly in severe infections. Syndromic molecular diagnostics have been introduced to overcome the limitations of conventional culture-based methods. This study evaluated the diagnostic performance and real-life implementation of BioFire^® FilmArray^® syndromic panels compared with routine microbiological diagnostics. Methods: A total of 955 clinical specimens collected between 2022 and June 2025 were retrospectively analyzed, including positive blood cultures (n = 400), lower respiratory tract samples (n = 309), cerebrospinal fluid (n = 158) and stool specimens (n = 88). FilmArray^® BCID2, Pneumonia Plus, Meningitis/Encephalitis and Gastrointestinal panels were performed on the Biofire Fimarray^® instrument according to clinical indication and compared with conventional culture-based identification and phenotypic antimicrobial susceptibility testing. Results: Overall diagnostic concordance between BioFire^® FilmArray^® syndromic panels and conventional methods was high across all specimen types, with the highest positive percent agreement (PPA) observed for bloodstream infections (97.7%) and gastrointestinal pathogens (100%). In respiratory samples, the Pneumonia Plus panel detected a considerable number of microorganisms that could not be identified by culture, including viral pathogens and fastidious bacteria. Molecular detection of antimicrobial resistance markers showed excellent concordance with phenotypic profiles, with 100% agreement for CTX-M, carbapenemases (KPC, NDM, OXA-48-like, IMP), and vanA/B, while lower concordance was observed for mecA/C in staphylococci. In parallel, semi-quantitative bacterial loads provided by the Pneumonia Plus panel showed a strong essential agreement with culture-based quantification (97.4%, ±1 log₁₀). Across all panels, syndromic testing significantly reduced diagnostic turnaround time. Conclusions: Syndromic molecular panels provide rapid and reliable simultaneous detection of pathogens, as well as early resistance marker detection, thereby supporting timely antimicrobial optimization and stewardship when integrated with conventional microbiological diagnostics. Full article

Background/Objectives: Miller–Fisher syndrome (MFS) is a rare Guillain–Barré variant defined by ophthalmoplegia, ataxia, and areflexia. Pediatric MFS is uncommon, and infectious triggers remain underrecognized. Human herpesvirus 6 (HHV-6) is neurotropic but rarely linked to immune-mediated neuropathies. In this paper, we describe a child with MFS associated with HHV-6 detected in cerebrospinal fluid (CSF) and review reported pediatric infections related to MFS. Methods: A 5-year-old girl presented with acute ophthalmoplegia, ataxia, and diminished reflexes. Neuroimaging, ophthalmologic tests, CSF analyses, and serologic andpolymerase chain reaction (PCR) assays were performed, including multiplex reverse transcription–PCR of cerebrospinal fluid using the BioFire^® Meningitis/Encephalitis panel. A literature search was performed on Pubmed to identify pediatric (0–18 years) MFS cases with infectious triggers. Two reviewers independently screened and summarized the literature, and a PRISMA-style flow diagram was used to transparently report the study selection process. Results: HHV-6 DNA was detected via CSF PCR twice, while tests for other pathogens were negative. Anti-GQ1b and related antibodies were negative or borderline. The patient received intravenous immunoglobulin and corticosteroids, with full recovery after one month. Among 20 published pediatric cases (1997–2021), Campylobacter jejuni was most frequent, followed by Mycoplasma pneumoniae and influenza viruses. Anti-GQ1b IgM positivity and favorable outcomes were commonly reported, including cases managed conservatively. Conclusions: This case raises the hypothesis that HHV-6 may represent a potential post-infectious association in pediatric MFS. The review findings indicate that pediatric MFS generally follows infection, responds well to immunotherapy, and has an excellent prognosis. Viral testing may be considered in selected, hypothesis-generating contexts in atypical or seronegative pediatric MFS presentations. Full article

Respiratory infections represent one of the leading causes of pediatric consultations and hospitalizations in Chile, where rapid etiological identification is essential for clinical decision-making. We evaluated the impact of implementing the BIOFIRE^® SPOTFIRE^® Respiratory (R) Panel in the pediatric Emergency Department of a public referral hospital in Santiago, using a pre–post cross-sectional design comparing two winter periods (July 2023 vs. July 2024). Clinical records, laboratory data, and operational indicators were analyzed to assess changes in diagnostic yield, turnaround time, hospitalizations, discharges, supplementary test requests, and antimicrobial use. A total of 470 patients were included (224 in 2023; 246 in 2024). The etiological detection rate increased from 58.0% to 87.8% after the implementation of Spotfire^® (p < 0.0001), with marked increases in the identification of adenovirus, RSV, rhinovirus/enterovirus, and seasonal coronaviruses. Rapid molecular testing was associated with a significant rise in emergency department discharges (23.7% vs. 57.3%; p < 0.0001) and a reduction in hospitalizations (76.3% vs. 42.7%; p < 0.0001) and readmissions (9.2% vs. 0.5%; p < 0.0001). Requests for complete blood counts, chest X-rays, and antimicrobial prescriptions at discharge also decreased significantly. These effects persisted in key subgroups, including infants and children with comorbidities. In this high-demand winter setting, the BIOFIRE^® SPOTFIRE^® R Panel improved diagnostic performance and supported more efficient and targeted clinical management. Full article

Background/Objectives: Syndromic multiplex PCR assays such as BIOFIRE FilmArray^® Pneumonia (PN) panel enable rapid and simultaneous detection of bacterial and viral pathogens in respiratory specimens, improving diagnostic accuracy and patient management in lower respiratory tract infections (LRTIs). Methods: In this retrospective observational study, PN panel results in 410 bronchoalveolar lavage (BAL) samples from hospitalized patients with suspected pneumonia were analyzed and compared with those obtained using the conventional culture (CC) method. Results: The PN panel showed an overall positivity rate of 54%, detecting bacteria in 39.0% of samples, viruses in 7.1%, and atypical bacteria in 2.2%. Using the conventional culture (CC) method, 33.9% of samples tested positive. Overall, 83 (20.2%) samples that were positive by the PN panel were negative by CC, whereas only 14 specimens (3.4%) were positive by CC and negative by PN panel. The most frequently detected pathogen by both the PN panel and CC was Staphylococcus aureus (n = 67, 16.34% for PN; n = 40, 9.76% for CC). Regarding diagnostic performance, the PN panel demonstrated a sensitivity of 89.02%, a specificity of 97.86%, and an overall accuracy of 97.63%. Lower sensitivity values were observed only for the Enterobacter cloacae complex (57.14%) and the Klebsiella pneumoniae group (75%). Specificity exceeded 92% for all bacterial targets. Conclusions: The PN panel confirms enhanced pathogen detection and a shortened time-to-result. It serves as a valuable adjunct for the timely diagnosis of LRTIs, supporting antimicrobial stewardship through more precise and appropriate antibiotic selection. Full article

Background: Bordetella pertussis causes pertussis, a respiratory infection with whooping cough. Despite a high vaccine coverage, pertussis resurged post-COVID-19 pandemic. Meanwhile, isolates resistant to macrolides—the first-line therapy—have increased in several countries, including Japan. Culturing B. pertussis and detecting resistance are difficult; reports remain limited in Japan. Methods: From March to August 2025, we collected nasopharyngeal samples from children aged 0–15 years with suspected pertussis at six Japanese clinics. Pediatricians obtained swabs and tested them using gene-amplification kits (e.g., BioFire^® SpotFire^® in four clinics, LAMP Pertussis Detection^® in two clinics). B. pertussis was confirmed by PCR; isolates were sequenced to identify macrolide-resistant mutations. Results: Samples were taken from 54 children, the number of boys and girls was 34 and 20, and their median age was 12 years old. Among 54 B. pertussis isolates, 43/52 (82.7%) sequenced strains harbored the A2047G mutation associated with macrolide resistance. Resistance rates at each clinic varied from 40% to 96%. Conclusions: These findings indicate a post-pandemic rise in macrolide-resistant B. pertussis in Japan. Ongoing resistance surveillance is essential, and repurposing residual clinical samples after routine testing is useful given culture and detection challenges. Full article

Background: Accurate identification of pneumonia pathogens is critical for guiding appropriate antibiotic therapy and minimizing unnecessary antimicrobial exposure. Bronchoalveolar lavage (BAL) is widely used for pathogen detection but introduces procedural risks. Bronchial washing (BW) is simpler and less invasive, yet evidence for its utility in multiplex PCR diagnostics is limited. Methods: This study includes an evaluation of the clinical utility of the BioFire^® FilmArray^® Pneumonia Panel (FA) using BW specimens via comparison with conventional culture. Between 2022 and 2024, 190 BW specimens were collected from 182 adult patients with suspected pneumonia at Eunpyeong St. Mary’s Hospital, Seoul, Korea. Each specimen was tested simultaneously using FA and conventional culture. Results: The culture positivity rate was 41.6%, whereas FA showed a higher positivity rate of 51.1%. Of all specimens, 52.6% (100/190) were positive in at least one of two methods, and 11.0% (21/190) were FA-positive only. FA detected 72 additional bacterial targets, most commonly H. influenzae, K. pneumoniae, S. aureus, S. agalactiae, and S. pneumoniae. Semi-quantitative results demonstrated a statistically significant moderate correlation with culture (ρ = 0.48, p < 0.001). Eight bacterial targets achieved 100% PPA, and resistance genes were rapidly detected, although some discrepancies with phenotypic antimicrobial susceptibility testing were observed. Several FA-only detections may reflect oropharyngeal colonization rather than true infection. Conclusions: FA testing of BW specimens demonstrated high concordance with culture and provided rapid pathogen and resistance gene detection. BW-based FA testing may serve as a useful diagnostic alternative when BAL is not feasible, although careful interpretation is required to account for potential contamination. Full article