What is BioFire (Biomerieux FilmArray)?

BioFire: A Multiplex Molecular Diagnostic System for Rapid Pathogen Detection

BioFire (BioMerieux FilmArray) is a rapid, automated multiplex PCR diagnostic system that can simultaneously detect multiple pathogens including bacteria, viruses, fungi, and antimicrobial resistance genes from clinical specimens in approximately 1-2 hours. 1

Key Features and Capabilities

• Technology: Uses multiplex PCR technology with self-contained cartridge-based testing platforms
• Testing Time: Results available in approximately 1-2 hours 2
• Sample Types: Compatible with various specimen types including:
  • Respiratory samples (nasopharyngeal swabs, BAL fluid) 1, 3
  • Blood cultures 1
  • Gastrointestinal samples 2
  • Lower respiratory tract specimens (sputum, BAL) 4, 5

Available BioFire Panels

1. Respiratory Panel:

   • Detects multiple respiratory viruses and bacterial pathogens
   • Approved specimen types include nasopharyngeal swabs, nasal swabs, nasal aspirates, and BAL fluid 1
   • Particularly valuable in immunocompromised patients 3

2. FilmArray Pneumonia/Pneumonia Plus Panel:

   • Detects 26 pathogens (18 bacteria and 8 viruses) and 7 antimicrobial resistance markers 5
   • Provides semiquantitative bacterial results 4
   • Shows significantly higher detection rates compared to conventional culture methods 5

3. Gastrointestinal Panel:

   • Combines 22 pathogens in a single test 2
   • Includes bacterial, viral, and parasitic causes of gastroenteritis
   • Higher detection rate compared to conventional methods (39.6% vs 28.6%) 2

4. Blood Culture Identification Panel:

   • Rapidly identifies pathogens from positive blood cultures
   • Detects antimicrobial resistance genes 1
   • Associated with earlier initiation of appropriate therapy and reduced mortality in bloodstream infections 1

Clinical Impact and Benefits

• Reduced Turnaround Time: Significantly faster than conventional methods (median 16 hours vs 53 hours for GI testing) 2
• Improved Infection Control: Allows for earlier discontinuation of isolation precautions 2
• Antimicrobial Stewardship: Enables more targeted antibiotic therapy and potential reduction in antibiotic use 1, 2
• Enhanced Detection: Higher sensitivity compared to conventional culture methods 4, 5
• Comprehensive Testing: Detects multiple pathogens simultaneously, including coinfections 6

Limitations and Considerations

• Cost: Higher per-test cost compared to conventional methods
• Interpretation Challenges: May detect colonization rather than active infection in some cases 1
• Resistance Detection: Limited to specific resistance markers; conventional antimicrobial susceptibility testing may still be needed 1
• Clinical Correlation: Results must be interpreted in the context of the patient's clinical presentation

Real-World Applications

• Respiratory Infections: Particularly useful during respiratory virus seasons when multiple pathogens circulate simultaneously 1
• Bloodstream Infections: Associated with faster time to appropriate therapy in carbapenem-resistant Enterobacterales infections 1
• Gastrointestinal Infections: Can prevent unnecessary diagnostic procedures and improve infection control 2
• Public Health Surveillance: The BioFire Syndromic Trends system aggregates deidentified test results for epidemiological monitoring 6

BioFire represents a significant advancement in rapid diagnostic testing for infectious diseases, offering clinicians the ability to quickly identify pathogens and make more informed treatment decisions, ultimately improving patient outcomes and supporting antimicrobial stewardship efforts.