Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis

Trujillo-Gómez, Juliana; Tsokani, Sofia; Arango-Ferreira, Catalina; Atehortúa-Muñoz, Santiago; Jiménez-Villegas, María José; Serrano-Tabares, C; Veroniki, Areti-Angeliki; Flórez, Iván D.

doi:10.1016/j.eclinm.2022.101275

Cited by 51 publications

(37 citation statements)

References 42 publications

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“…In general, data on clinical performance of the array in comparable settings are limited and, in contrast to our data, many of the available studies in patients with suspected CNS infection did not report on pathogens that were not covered by the array. or above [4,5]. Concerns about false-negative and false-positive results are primarily raised for HSV1 and HSV2 [12,13], which was also an issue in our study as we found one sample to be positive for HSV2 only by serology (array false-negative) and another sample to be only positive for HSV2 by PCR array (standard PCR and serology false-negative).…”

Section: Discussionmentioning

confidence: 64%

Cerebrospinal fluid analysis in emergency patients with suspected infection of the central nervous system

Völk

Dobler

Koedel

et al. 2022

Euro J of Neurology

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Background and purpose Meningitis and encephalitis are potentially life‐threatening diseases that require fast and accurate diagnostics and therapy. The value of polymerase chain reaction (PCR) multiplex testing in clinical practice is still a matter of debate. This study aims to evaluate its benefits and limitations in emergency patients. Methods We assessed the value of a meningoencephalitis PCR array in the clinical routine of an emergency department. Results Of 1578 emergency patients who received a lumbar puncture, 43% received it for a clinically suspected central nervous system (CNS) infection. After initial workup for cerebrospinal fluid (CSF) cell count, protein and glucose, a CNS infection was still considered likely in 307 patients. In these patients, further microbiologic workup was performed. A total of 230 samples were examined by PCR and a pathogen was detected in 66 of these samples. In the case of a positive microbiologic result, a comparison between PCR array and standard method was available for 59 samples, which demonstrated an overcall agreement of 80% (n = 47/59). Of interest, exclusively array‐positive results were observed for patients with meningitis found to be positive for Streptococcus pneumoniae; four out of five patients had been treated with antibiotics before the lumbar puncture. In samples with normal CSF cell count only two positive array results were obtained, both for human herpesvirus 6, and these were not clinically relevant. Conclusion Our data suggest that the array substantially contributes to a detection of pathogens in patients with suspected CNS infection and seems of particular interest in patients with acute bacterial meningitis under empiric antibiotic treatment. In CSF samples with normal cell count, it might be dispensable.

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Section: Discussionmentioning

confidence: 64%

Cerebrospinal fluid analysis in emergency patients with suspected infection of the central nervous system

Völk

Dobler

Koedel

et al. 2022

Euro J of Neurology

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“…All multiplex panels are limited to the targets they can detect as well as providing limited or no information about the resistance. The only commercially available multiplex panel for meningoencephalitis, the FilmArray Meningitis/Encephalitis (ME) Panel, is inadequate for use as a sole diagnostic test for SOTR due to (1) decreased sensitivity for certain targets, particularly Cryptococcus and HSV‐1, (2) the exclusion of important pathogens of immunocompromised hosts (such as Mycobacterium tuberculosis or Toxoplasma gondii ), and (3) the lack of susceptibility data needed to tailor therapy for bacterial and fungal pathogens 5–8 . Positive results do not exclude the possibility of coinfection with an off‐panel organism while detection of herpesviruses (especially HHV6) may represent reactivation of latent virus without disease or expression of chromosomally‐integrated HHV6 9 …”

Section: Consensus Conference Findingsmentioning

confidence: 99%

“…The only commercially available multiplex panel for meningoencephalitis, the FilmArray Meningitis/ Encephalitis (ME) Panel, is inadequate for use as a sole diagnostic test for SOTR due to (1) decreased sensitivity for certain targets, particularly Cryptococcus and HSV-1, (2) the exclusion of important pathogens of immunocompromised hosts (such as Mycobacterium tuberculosis or Toxoplasma gondii), and (3) the lack of susceptibility data needed to tailor therapy for bacterial and fungal pathogens. [5][6][7][8] Positive results do not exclude the possibility of coinfection with an off-panel organism while detection of herpesviruses (especially HHV6) may represent reactivation of latent virus without disease or expression of chromosomally-integrated HHV6. 9 For pneumonia, upper respiratory tract (URT) panels may be potentially useful as part of the initial workup of SOTR presenting with diffuse infiltrates on chest imaging because of the inclusion of multiple viral targets that may produce a compatible radiographic picture as well as viruses for which treatment is available and particularly indicated in SOTR (influenza, SARS-CoV-2, ADV, RSV).…”

Section: Multiplex Molecular Assaysmentioning

confidence: 99%

A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients

Azar

Turbett

Gaston

et al. 2022

American Journal of Transplantation

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A virtual consensus conference proposal on advanced diagnostics for transplant infectious diseases was submitted by the AST Transplant Diagnostics Community of Practice (TxDxCOP) for consideration and subsequently approved for funding. The consensus conference was fully virtual; participants received no funds from private enterprises. AST provided organizational and technical support for pre-conference and conference proceedings. A steering committee comprising members of TxDxCOP and the Infectious Diseases Community of Practice developed conference definitions, aims, scope, and format. Advanced or novel assays were defined as assays with the capacity for one or more of the following: To detect (1) pathogens, (2) genotypic or phenotypic antimicrobial susceptibility, or (3) pathogen-specific host responses, with an enhanced range of target detection, sensitivity, specificity, speed and/or simplicity of use, relative to conventional methods. Assay categories that met the above definition and for which some data on clinical performance/utility was available were included in this consensus conference.

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“…A 2019 systematic review and meta-analysis reported a sensitivity of 90% (95% CI 86−93%) and a specificity of 97% (95% CI 94−99%) for the multiplex ME panel at identifying the causative pathogen in patients with suspected meningitis/encephalitis [ 1 ]. Additionally, a 2022 systematic review found that the multiplex ME panel had an estimated sensitivity of 89.5% (95% CI 81.1−94.4) and specificity of 97.4% (95% CI 94.0−98.9) for all bacteria, though heterogeneity was observed in the panel’s sensitivities for certain pathogens [ 7 ]. The multiplex ME panel has also been reported to yield rapid results compared to standard care; turnaround time averaged 2.2 to 6.2 h, compared with 24 h in control groups [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Impact of a Meningitis/Encephalitis Panel on Hospital Length of Stay: A Systematic Review and Meta-Analysis

et al. 2022

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Meningitis and encephalitis are central nervous system infections with considerable morbidity and mortality. The BioFire® FilmArray® Meningitis/Encephalitis Panel (multiplex ME panel) can identify pathogens rapidly potentially aiding in targeted therapy and curtail antimicrobial exposure. This systematic review and meta-analysis synthesized the literature on the association between the multiplex ME panel and length of hospital stay (LOS), length of acyclovir therapy, and days with antibiotics. MEDLINE and EMBASE were searched. Only studies presenting novel data were retained. Random-effects meta-analyses were performed to assess the impact of the multiplex ME panel on outcomes. Of 169 retrieved publications, 13 met the criteria for inclusion. Patients tested with the multiplex ME panel had a reduction in the average LOS (mean difference [MD] [95% CI]: −1.20 days [−1.96, −0.44], n=11 studies). Use of the multiplex ME panel was also associated with a reduction in the length of acyclovir therapy (MD [95% CI]: −1.14 days [−1.78, −0.50], n=7 studies) and a nonsignificant reduction in the average number of days with antibiotics (MD [95% CI]: −1.01 days [−2.39, 0.37], n=6 studies). The rapidity of pathogen identification contributes to an overall reduced LOS, reductions in the duration of empiric antiviral utilization, and a nonsignificant reduction in antibiotic therapy.

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Biofire FilmArray Meningitis/Encephalitis panel for the aetiological diagnosis of central nervous system infections: A systematic review and diagnostic test accuracy meta-analysis

Cited by 51 publications

References 42 publications

Cerebrospinal fluid analysis in emergency patients with suspected infection of the central nervous system

Cerebrospinal fluid analysis in emergency patients with suspected infection of the central nervous system

A consensus conference to define the utility of advanced infectious disease diagnostics in solid organ transplant recipients

Assessment of the Impact of a Meningitis/Encephalitis Panel on Hospital Length of Stay: A Systematic Review and Meta-Analysis

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