{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:55:29Z","timestamp":1791950129968,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rapid diagnostics such as the BIOFIRE\u00ae FILMARRAY\u00ae Pneumonia (PN) Panel may enhance antibiotic optimization, yet real-world evidence remains limited, and few studies have assessed how differences in institutional antimicrobial stewardship (ASP) capacity influence clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a national, multicenter retrospective study of ICU patients with pneumonia admitted to Veterans Health Administration hospitals. Hospitals that implemented the PN Panel for \u22656 months served as intervention sites, while matched facilities without implementation served as controls. Outcomes were assessed using a difference-in-differences framework with inverse probability weighting to account for baseline imbalances and secular trends, including those related to the COVID-19 pandemic. Co-primary outcomes, assessed following index culture collection, were early antimicrobial de-escalation (24\u201348 hours) and early appropriate therapy (0\u201324 hours); secondary outcomes were 30-day and ICU mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 11 746 patients, including 4523 from hospitals that implemented the BIOFIRE\u00ae PN Panel and 7223 from matched control hospitals. Overall, PN implementation was associated with early antimicrobial de-escalation (adjusted RR [aRR], 1.14; 95% CI, 1.04\u20131.26). Among culture-positive patients, PN Panel implementation was significantly associated with early antimicrobial de-escalation (aRR, 1.23; 95% CI, 1.02\u20131.50) and early appropriate therapy (aRR, 1.11; 95% CI, 1.04\u20131.18). Overall ICU and 30-day mortality did not differ, though ICU mortality among culture-positive patients was relatively lower following PN Panel implementation (aRR, .70; 95% CI, 0.50\u20130.97). Improvements in antimicrobial optimization were most evident in hospitals with greater ASP capacity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BIOFIRE\u00ae PN Panel implementation improved antibiotic optimization in critically ill pneumonia patients, with the greatest gains seen in hospitals with comprehensive ASP programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag328","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T11:46:34Z","timestamp":1780055194000},"page":"e461-e471","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Impact of the BIOFIRE\u00ae FILMARRAY\u00ae Pneumonia Panel in the Veterans Affairs Healthcare System: A Difference-in-Differences Study"],"prefix":"10.1093","volume":"83","author":[{"given":"Nicholas S","family":"Britt","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, University of Kansas School of Pharmacy , Lawrence, Kansas ,","place":["USA"]},{"name":"Department of Internal Medicine, University of Kansas School of Medicine , Kansas City, Kansas ,","place":["USA"]},{"name":"Dwight D. Eisenhower Veterans Affairs Medical Center Pharmacy Service, , Leavenworth, Kansas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7206-8077","authenticated-orcid":false,"given":"Karim","family":"Khader","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah ,","place":["USA"]},{"name":"IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"He","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Utah School of Medicine , Salt Lake City, Utah ,","place":["USA"]},{"name":"IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System , Salt Lake City, Utah ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2949-5484","authenticated-orcid":false,"given":"Andrea M","family":"Prinzi","sequence":"additional","affiliation":[{"name":"bioM\u00e9rieux, Marcy L\u2019etoile ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Hommel","sequence":"additional","affiliation":[{"name":"bioM\u00e9rieux, Marcy L\u2019etoile ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4542-6203","authenticated-orcid":false,"given":"Tristan T","family":"Timbrook","sequence":"additional","affiliation":[{"name":"Barnes-Jewish Hospital Pharmacy Department, , St. Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M","family":"Potter","sequence":"additional","affiliation":[{"name":"Dwight D. Eisenhower Veterans Affairs Medical Center Pharmacy Service, , Leavenworth, Kansas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4730-0655","authenticated-orcid":false,"given":"Thomas P","family":"Lodise","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences , Albany, New York ,","place":["USA"]},{"name":"Samuel S. Stratton Veterans Affairs Medical Center Pharmacy Serivce, , Albany, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"2026100713422468600_ciag328-B1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/CCM.0000000000003553","article-title":"A comparison of the mortality risk associated with ventilator-acquired bacterial pneumonia and nonventilator ICU-acquired bacterial pneumonia","volume":"47","author":"Ibn Saied","year":"2019","journal-title":"Crit Care Med"},{"key":"2026100713422468600_ciag328-B2","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s12931-016-0397-5","article-title":"Risk factors for mortality in patients admitted to intensive care units with pneumonia","volume":"17","author":"Li","year":"2016","journal-title":"Respir Res"},{"key":"2026100713422468600_ciag328-B3","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2026100713422468600_ciag328-B4","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1186\/s13054-025-05632-z","article-title":"Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study","volume":"29","author":"Giacobbe","year":"2025","journal-title":"Crit Care"},{"key":"2026100713422468600_ciag328-B5","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1186\/s13054-025-05623-0","article-title":"Impact of syndromic molecular diagnostics on antimicrobial adequacy and time to therapy in critically ill patients with pneumonia: a systematic review and meta-analysis of randomized trials","volume":"29","author":"de Albuquerque Pessoa Dos Santos","year":"2025","journal-title":"Crit Care"},{"key":"2026100713422468600_ciag328-B6","article-title":"Impact of Multiplex PCR in the therapeutic management of severe bacterial pneumonia","volume":"13","author":"Dessajan","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"2026100713422468600_ciag328-B7","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1017\/ash.2022.358","article-title":"Clinical impact of a multiplex rapid diagnostic pneumonia panel in critically ill patients","volume":"3","author":"Esplund","year":"2023","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"2026100713422468600_ciag328-B8","article-title":"Evaluation and clinical impact of Biofire FilmArray pneumonia panel plus in ICU-hospitalized COVID-19 patients","volume":"12","author":"Escudero","year":"2022","journal-title":"Diagnostics (Basel)"},{"key":"2026100713422468600_ciag328-B9","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1186\/s13054-020-03067-2","article-title":"Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia","volume":"24","author":"Peiffer-Smadja","year":"2020","journal-title":"Crit Care"},{"key":"2026100713422468600_ciag328-B10","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1093\/cid\/ciae234","article-title":"Rapid diagnostic tests and antimicrobial stewardship programs for the management of bloodstream infection: what is their relative contribution to improving clinical outcomes? 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