A Tertiary Care Center’s Experience with Novel Molecular Meningitis/Encephalitis Diagnostics and Implementation with Antimicrobial Stewardship

Chang, David C.; Okulicz, Jason F.; Nielsen, Lindsey; White, Brian

doi:10.1093/milmed/usx025

Cited by 24 publications

(12 citation statements)

References 16 publications

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“…This is one of the first studies to evaluate the clinical impact of an in-house multiplex PCR assay on the care of adult patients admitted from the community with a suspected CNS infection. Similar to prior studies, we found a significantly reduced diagnostic TAT and a reduction in antiviral therapy [2,7,9,10,14]. Additionally, our study included a diverse patient population by incorporating both a quaternary academic referral center as well as a community-based teaching hospital.…”

Section: Discussionsupporting

confidence: 78%

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Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

et al. 2020

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Patients admitted from the community with a suspected central nervous system (CNS) infection require prompt diagnostic evaluation and correct antimicrobial treatment. A retrospective, multicenter, pre/post intervention study was performed to evaluate the impact that the BioFire® FilmArray® meningitis/encephalitis (ME) panel run in-house had on the clinical management of adult patients admitted from the community with a lumbar puncture (LP) performed for a suspected CNS infection. The primary outcome was the effect that this intervention had on herpes simplex virus (HSV) polymerase chain reaction (PCR) turnaround time (TAT). Secondary outcomes included the effect that this intervention had on antiviral days of therapy (DOT), total antimicrobial DOT, and hospital length of stay (LOS). A total of 81 and 79 patients were included in the pre-intervention and post-intervention cohorts, respectively. The median HSV PCR TAT was significantly longer in the pre-intervention group (85 vs. 4.1 h, p < 0.001). Total antiviral DOT was significantly greater in the pre-intervention group (3 vs. 1, p < 0.001), as was total antimicrobial DOT (7 vs. 5, p < 0.001). Pre-intervention hospital LOS was also significantly longer (6.6 vs. 4.4 days, p = 0.02). Implementing the ME panel in-house for adults undergoing an LP for a suspected community-onset CNS infection significantly reduced the HSV PCR TAT, antiviral DOT, total antimicrobial DOT, and hospital LOS.

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Section: Discussionsupporting

confidence: 78%

“…Often, patients that undergo CSF analyses remain on broad antimicrobial coverage while waiting days for diagnostic results [2]. This delay can result in preventable harm from unnecessary drug exposure, as well as prolonged hospital stays.…”

Section: Introductionmentioning

confidence: 99%

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

et al. 2020

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“…Recently, molecular tools allowing a syndromic approach to M/E diagnosis have become available. As the results are available in around 1 hour, these approaches are of great interest despite their costs, considering the clinical importance of M/E and the potential for improvement in adequate antimicrobial treatment [7].…”

Section: Introductionmentioning

confidence: 99%

A review of a 13-month period of FilmArray Meningitis/Encephalitis panel implementation as a first-line diagnosis tool at a university hospital

et al. 2019

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Early diagnosis and treatment of meningitis and encephalitis is essential for reducing both their morbidity and mortality. The FilmArray® Meningitis/Encephalitis (FA-M/E) panel is a recently available molecular tool allowing the simultaneous detection of 14 pathogens in about one hour. We evaluated its routine use over a 13-month period at Nîmes University Hospital, France. Cerebrospinal fluid (CSF) specimens were prospectively analyzed, independently of cell count; results were retrospectively analyzed and positive results compared to clinical and microbiological data. Among the 708 patients included (734 CSF samples), 89 (12.6%) had a positive FA-M/E panel, 71 (80%) for a viral pathogen and 18 (20%) for a bacterial pathogen. Enterovirus and HHV-6 were the main detected pathogens. Mean time-to-results was 1h46mn. Four non-clinically relevant results were detected (3 HHV-6 and 1 Haemophilus influenzae) on the basis of inconsistent clinical and/or biological data, and/or after visualization of melting curves. No CSF pleocytosis was observed in 11% of the patients with a positive FA-M/E panel. For the 18 patients with a positive FA-M/E panel for a bacterial pathogen, five (28%) had CSF samples showing a positive Gram stain allowing an early diagnosis of bacterial infection and 67% had CSF displaying a positive culture. Altogether the panel detected 5 cases of bacterial M/E (29%) not diagnosed by culture. Despite undeniable advantages, mainly ease of use, quick result availability, and an extremely low rate of invalid results, measures should be implemented to limit false-positive results due to contamination and a careful interpretation based on the overall data for each patient is required.

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“…A recent study evaluated the cost-effectiveness of setting up the ME panel, it was found that the main benefit from the economic point of view was in the decrease in the consumption of antimicrobials [16]. This finding contrasts with another study [10] where there was no timely suspension of inappropriate therapy according to the results of the panel, which reinforces the importance of the implementation of the test in the context of an antimicrobial stewardship programme.…”

Section: Discussionmentioning

confidence: 98%

“…The main limitation of this panel is with C. neoformans where it can be as low as 50% [8]. So far, studies have been carried out mainly in the pediatric population and in immunocompetent patients with overall good performance, although only approximately 25% of the film array panels are positive [9, 10]. Currently, there are no studies evaluating the performance of this panel in Latin America.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Film Array Meningitis/Encephalitis panel in adults with meningitis and encephalitis in Colombia

et al. 2020

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The Biofire® Film Array Meningitis Encephalitis (FAME) panel can rapidly diagnose common aetiologies but its impact in Colombia is unknown. A retrospective study of adults with CNS infections in one tertiary hospital in Colombia. The cohort was divided into two time periods: before and after the implementation of the Biofire® FAME panel in May 2016. A total of 98 patients were enrolled, 52 and 46 were enrolled in the Standard of Care (SOC) group and in the FAME group, respectively. The most common comorbidity was human immunodeficiency virus infection (47.4%). The median time to a change in therapy was significantly shorter in the FAME group than in the SOC group (3 vs. 137.3 h, P < 0.001). This difference was driven by the timing to appropriate therapy (2.1 vs. 195 h, P < 0.001) by identifying viral aetiologies. Overall outcomes and length of stay were no different between both groups (P > 0.2). The FAME panel detected six aetiologies that had negative cultures but missed identifying one patient with Cryptococcus neoformans. The introduction of the Biofire FAME panel in Colombia has facilitated the identification of viral pathogens and has significantly reduced the time to the adjustment of empirical antimicrobial therapy.

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A Tertiary Care Center’s Experience with Novel Molecular Meningitis/Encephalitis Diagnostics and Implementation with Antimicrobial Stewardship

Cited by 24 publications

References 16 publications

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

A review of a 13-month period of FilmArray Meningitis/Encephalitis panel implementation as a first-line diagnosis tool at a university hospital

Impact of the Film Array Meningitis/Encephalitis panel in adults with meningitis and encephalitis in Colombia

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