Real-life evaluation of BioFire® BCID2 and Vitek® REVEALTM for Gram-negative bloodstream infections in critical care.

Abstract

Timely management of sepsis relies on rapid diagnosis of bloodstream infections (BSIs), including early pathogen identification and antimicrobial susceptibility testing (AST). The Vitek® REVEALTM is an innovative rapid AST platform that detects volatile organic compounds emitted by Gram-negative bacilli (GNB) directly from positive blood cultures. This study assessed the analytical performance and clinical contribution of the BioFire® BCID2 molecular panel and the Vitek® REVEALTM system in the diagnosis of GNB-BSI among intensive care unit (ICU) patients. We analyzed the prospective phase of the BacteREVEAL study, conducted between March and October 2023 at Nîmes University Hospital. Results from BioFire® BCID2 and Vitek® REVEALTM were compared to standard-of-care methods, including MALDI-TOF identification and direct disk diffusion AST. Performance metrics for Vitek® REVEALTM were evaluated according to ISO 20776-2:2007 standards. Among 94 ICU patients with a first episode of GNB-BSI, 50 monomicrobial cases were included. Escherichia coli was the most frequently identified species (n = 30, 60%), followed by Pseudomonas aeruginosa (n = 7, 14%). BioFire® BCID2 provided accurate identification for all isolates. The innovative tools reduced median turnaround times for identification by 19.0 h and for AST by 14.9 h. The mean time to result for Vitek® REVEALTM was 5.7 h. Overall categorical agreement with standard AST was 97.7%, with 8 very major errors, 8 major errors, and 2 minor errors. These findings support the integration of BioFire® BCID2 and Vitek® REVEALTM into routine workflows to accelerate GNB-BSI diagnosis and improve sepsis management.