Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study

Abstract

Background: Prompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis. However, in children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. Novel multiplex PCR (mPCR) panels provide rapid on-site diagnostic testing for a variety of pathogens. This study compared empiric antibiotic and acyclovir usage before and after the introduction of an on-site FilmArray Meningitis/Encephalitis Panel (FA ME Panel). Methods: We retrospectively compared data for empiric antibiotic and acyclovir usage between pediatric patients with suspected central nervous system (CNS) infection receiving mPCR testing and a matched historical control group. Patients were matched by age and suspected CNS infection. We included all patients for whom empiric antibiotics and/or acyclovir were prescribed. Results: Each study group consisted of 46 patients with 29 (63.0%) infants and 17 (37.0%) older children. A viral pathogen was diagnosed in 5/46 (10.9%) patients in the control group (all enteroviruses) and in 14/46 (30.4%) patients in the mPCR group (enterovirus n = 9; human herpesvirus 6 (HHV-6) n = 5), (p = 0.038)). Length of Therapy (LoT) and Days of Therapy (DoT) for antibiotics were significantly lower for infants (4.0 vs. 3.0, p = 0.038 and 8.0 vs. 6.0, p = 0.015, respectively). Acyclovir therapy was significantly shorter for both, infants and older children (3.0 vs. 1.0 day, p < 0.001 for both age groups). Conclusion: The findings of our study suggest that the introduction of a FA ME Panel into clinical routine procedures is associated with a significantly reduced LoT and DoT of empiric anti-infective treatment in children with suspected meningoencephalitis. The largest effect was observed in infants.

Panels and Syndromic Testing in Clinical Microbiology

“…One clear-cut benefit of FA-ME is the significant improvement in herpes simplex virus (HSV) turnaround time, which can lead to decreased acyclovir exposure. 15 , 16 Early diagnosis of aseptic meningitis through detection of enterovirus or parechovirus can allow providers to avoid antibiotics and possibly negate the need for hospital admissions. 17 Limited data have been published on the economic benefits and patient outcomes associated with the FA-ME, but the data we have report hospital cost savings and decreased length of stay.…”

Current Status of Clinical Application of Point-of-Care Testing

“…Use of the FilmArray Respiratory Panel for detecting influenza A (H1 and H3), influenza B, respiratory syncytial virus, rhinovirus, enterovirus, human metapneumovirus, parainfluenza virus types 1 through 4, coronaviruses (OC43, 229E, HKU1, and NL63), and adenovirus was associated with reduced length of stay, improved influenza detection, and antiviral use, and appeared to be safe. 105 Hagen et al 108 suggested that introduction of a FilmArray meningitis/encephalitis panel into routine clinical procedures is associated with significantly reduced length and days of therapy for empiric antiinfective treatment in children with suspected meningoencephalitis (4.0 versus 3.0, P ¼ .04, and 8.0 versus 6.0, P ¼ .02, respectively). Patients with exacerbation of airway disease should undergo respiratory virus testing at the POC using a comprehensive syndromic multiplex panel rather than a molecular POCT for influenza alone, which would not detect the majority of viruses associated with early antibiotic discontinuation.…”

Impact of a Rapid Diagnostic Meningitis/Encephalitis Panel on Antimicrobial Use and Clinical Outcomes in Children

“…More recently, several studies demonstrated cost savings and reductions in antibiotic days of therapy (DoT) with implementation of the MEP [ 17 , 18 , 19 , 20 , 21 ]. Nabower et al demonstrated decreased length of stay (LOS) and fewer acyclovir doses administered, while Weber et al demonstrated hospital cost savings in a military treatment facility [ 17 , 18 ].…”

“…Posnakoglou et al supplemented these findings, demonstrating decreased LOS, a reduction in antimicrobial use, and a decrease in total cost [ 19 ]. Similarly, Hagen et al noted a decreased duration of empiric therapy, with the largest effect documented in infants [ 20 ]. Messacar et al focused on herpes simplex virus in patients >60 days of age and observed a doubling of herpes simplex virus testing with a reduction in acyclovir duration of therapy [ 21 ].…”