Assessment of the FilmArray® multiplex PCR system and associated meningitis/encephalitis panel in the diagnostic service of a tertiary hospital

Mostyn, Amanda; Lenihan, Marie; O’Sullivan, Donnchadh; Woods, Sara; O’Hara, Maureen; Powell, James; Power, Lorraine; O’Connell, Nuala H.; Dunne, Colum P.

doi:10.1016/j.infpip.2020.100042

Cited by 9 publications

(15 citation statements)

References 16 publications

(23 reference statements)

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“…Macroscopic appearance of the CSF is reported. UHL laboratory protocols for CSF testing are similar to those reported previously in our study of the FilmArray ME panel [ 18 ]. Leucocytes and erythrocytes were quantified by manual microscopy using a KOVA Glasstic Slide counting chamber in which 1μl of CSF was assessed using manual light microscopy.…”

Section: Methodsmentioning

confidence: 69%

“…Further, due to the lack of electronic patient or prescribing records, the impact of the FilmArray ME panel on antimicrobial and antiviral prescribing for patients with suspicion of a CNS infection could not be confirmed. A cost analysis was not performed for the purpose of this study as this was completed for our previous study [ 18 ]. The cessation of Gram stain in our hospital was appropriate, considering only one bacterial target was missed.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a chocolate agar (Oxoid) was incubated in 5% CO 2 at 35–37° for 48 hours. Subsequent to our previous study outcomes [ 18 ], Gram staining of CSF is no longer included in routine testing. All CSF samples with >5 leucocytes/μL underwent analysis using the FilmArray ME panel.…”

Section: Methodsmentioning

confidence: 99%

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Outcomes of implementation of the FilmArray meningoencephalitis panel in a tertiary hospital between 2017 and 2020

et al. 2022

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Background Acute meningoencephalitis is encountered commonly in the acute hospital setting and is associated with significant morbidity and mortality, in addition to significant healthcare costs. Multiplex PCR panels now allow syndromic testing for central nervous system infection. The BioFire® FilmArray® Meningoencephalitis (ME) allows testing of 14 target pathogens using only 0.2mls of cerebrospinal fluid (CSF). We conducted a retrospective observational study to assess the performance of the assay and secondarily to observe the clinical utility of negative results by comparing clinical outcomes of aseptic meningitis to bacterial and viral meningoencephalitis. Methods Data for CSF samples tested using the FilmArray ME panel from October 2017 to October 2020 were analysed. Detection of bacterial and viral targets was analysed. Admission to critical care area, 90-day readmission rates, average length of stay and 30-day and 90-day mortality were analysed for three groups with following diagnoses: bacterial meningitis, viral meningoencephalitis, or aseptic meningitis. Results From October 2017 to October 2020, 1926 CSF samples were received in the Clinical Microbiology laboratory. Of those, 543 CSF samples from 512 individual patients were tested using the FilmArray ME panel. Twenty-one bacterial targets and 56 viral targets were detected during the study period. For viral targets, the cumulative specificity was 98.9% (95% confidence interval: 93.1–99.9) when compared to the reference laboratory methods. The outcomes for 30- and 90-day mortality of the aseptic meningitis group were non-inferior relative to the viral meningoencephalitis and bacterial meningitis group. Patients with bacterial meningitis had a longer average length of stay. Aseptic meningitis was associated with a higher 90-day readmission rate than the other 2 groups, but without statistical significance. Conclusion In our hands, implementation of the FilmArray ME panel was relatively straightforward. We experienced a transition in our workflow processes that enabled streamlining of CSF diagnostics and the safe removal of Gram staining in those samples being tested by this molecular assay. Coupled to this improvement, there was a positive clinical impact on patient care due to rapid turnaround time to results.

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Section: Methodsmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Outcomes of implementation of the FilmArray meningoencephalitis panel in a tertiary hospital between 2017 and 2020

et al. 2022

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“…The automated multiplex-PCR systems such as FilmArray ® System, are also emerging as useful modalities in the diagnosis of ABM, but their relatively higher cost makes their utility less feasible. [ 28 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical use of multiplex-PCR for the diagnosis of acute bacterial meningitis

Gautam

Sharma

Tyagi

et al. 2022

Journal of Family Medicine and Primary Care

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Background and Objectives: Prompt and accurate diagnosis of acute bacterial meningitis (ABM) is critical for patient management. We designed and evaluated two sets of multiplex-PCR assays for the simultaneous detection of six major etiologies of ABM i.e., Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis in one set and Listeria monocytogenes, Streptococcus agalactiae, and Escherichia coli in another set of multiplex-PCR in CSF of patients with suspected ABM. Methods: A total of 113 CSF specimens from patients of all ages having clinical features suggestive of meningitis were tested for bacteriological evidence by Gram’s smear, culture, and our designed multiplex-PCR. Results: Multiplex-PCR assay performed excellently by increasing the overall detection rate by 6% when compared to culture as of total 113 samples tested, 17 (15%) were positive by multiplex-PCR whereas only 9% (10/113) were positive by culture. It detected the DNA in eight culture negative samples revealing the presence of S. pneumoniae in three and other possible bacterial pathogens in five of them. Our assay showed a DNA detection limit of 1 pg/μL. Compared to CSF culture, the sensitivity and specificity of the multiplex-PCR were 90% and 92.2%, respectively. Conclusion: This study accentuates the importance of multiplex-PCR assay that is efficiently fast and reliable for the diagnosis of acute bacterial meningitis that can substantially improve the diagnosis in culture negative cases, especially in patients who were previously started on antimicrobial therapy.

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“…New qualitative multiplexed techniques such as FilmArray Meningitis and Encephalitis Panel allow the study of up to 14 pathogens in 1 hour with a high sensitivity and specificity. 75 Studies have shown that the percentage of CNS aetiological diagnosis were higher in the group that had multiplex PCR testing, and this approach reduced the number of molecular biology techniques required to reach a diagnosis. 76 This technique may allow more causative agents to be identified in a single step and therefore should allow clinicians to better direct therapeutic interventions.…”

Section: Talk By Dr áLvaro Bonelli Rey Juan Carlos University Hospita...mentioning

confidence: 99%

Encephalitis: diagnosis, management and recent advances in the field of encephalitides

Alam

Easton

Nicholson

et al. 2022

Postgraduate Medical Journal

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Encephalitis describes inflammation of the brain parenchyma, typically caused by either an infectious agent or through an autoimmune process which may be postinfectious, paraneoplastic or idiopathic. Patients can present with a combination of fever, alterations in behaviour, personality, cognition and consciousness. They may also exhibit focal neurological deficits, seizures, movement disorders and/or autonomic instability. However, it can sometimes present non-specifically, and this combined with its many causes make it a difficult to manage neurological syndrome. Despite improved treatments in some forms of encephalitides, encephalitis remains a global concern due to its high mortality and morbidity. Prompt diagnosis and administration of specific and supportive management options can lead to better outcomes. Over the last decade, research in encephalitis has led to marked developments in the understanding, diagnosis and management of encephalitis. In parallel, the number of autoimmune encephalitis syndromes has rapidly expanded and clinically characteristic syndromes in association with pathogenic autoantibodies have been defined. By focusing on findings presented at the Encephalitis Society’s conference in December 2021, this article reviews the causes, clinical manifestations and management of encephalitis and integrate recent advances and challenges of research into encephalitis.

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Assessment of the FilmArray® multiplex PCR system and associated meningitis/encephalitis panel in the diagnostic service of a tertiary hospital

Cited by 9 publications

References 16 publications

Outcomes of implementation of the FilmArray meningoencephalitis panel in a tertiary hospital between 2017 and 2020

Outcomes of implementation of the FilmArray meningoencephalitis panel in a tertiary hospital between 2017 and 2020

Clinical use of multiplex-PCR for the diagnosis of acute bacterial meningitis

Encephalitis: diagnosis, management and recent advances in the field of encephalitides

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