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Utilization, Yield, and Accuracy of the FilmArray Meningitis/Encephalitis Panel with Diagnostic Stewardship and
M Jana Broadhurst1, Shefali Dujari2, Indre Budvytiene3
1Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
Abstract:
The impact of diagnostic stewardship and testing algorithms on the utilization and performance of the FilmArray meningitis/encephalitis (ME) panel has received limited investigation. We performed a retrospective single-center cohort study assessing all individuals with suspected ME between February 2017 and April 2019 for whom the ME panel was ordered. Testing was restricted to patients with cerebrospinal fluid (CSF) pleocytosis. Positive ME panel results were confirmed before reporting through correlation with direct staining (Gram and calcofluor white) and CSF cryptococcal antigen or by repeat ME panel testing. Outcomes included the ME panel test utilization rate, negative predictive value of nonpleocytic CSF samples, test yield and false-positivity rate, and time to appropriate deescalation of acyclovir. Restricting testing to pleocytic CSF samples reduced ME panel utilization by 42.7% (263 versus 459 tests performed) and increased the test yield by 61.8% (18.6% versus 11.5% positivity rate; P < 0.01) with the application of criteria. The negative predictive values of a normal CSF white blood cell (WBC) count for ME panel targets were 100% (195/195) for nonviral targets and 98.0% (192/196) overall. All pathogens detected in nonpleocytic CSF samples were herpesviruses. The application of a selective testing algorithm based on repeat testing of nonviral targets avoided 75% (3/4) of false-positive results without generating false-negative results. The introduction of the ME panel reduced the duration of acyclovir treatment from an average of 66 h (standard deviation [SD], 43 h) to 46 h (SD, 36 h) (P = 0.03). The implementation of the ME panel with restriction criteria and a selective testing algorithm for nonviral targets optimizes its utilization, yield, and accuracy.
Insights
Implementing diagnostic stewardship for the FilmArray meningitis/encephalitis (ME) panel, by restricting testing to pleocytosis and using selective algorithms, significantly improved test utilization, yield, and accuracy while reducing acyclovir treatment duration.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Diagnostic Stewardship
Background:
- The FilmArray meningitis/encephalitis (ME) panel is a valuable diagnostic tool, but its optimal utilization and performance require investigation.
- Limited research exists on the impact of diagnostic stewardship and specific testing algorithms on the ME panel's effectiveness.
Purpose of the Study:
- To evaluate the impact of diagnostic stewardship, specifically restricting testing to cerebrospinal fluid (CSF) with pleocytosis and employing a selective testing algorithm, on the utilization and performance of the FilmArray ME panel.
- To assess changes in test utilization rates, test yield, false-positivity rates, and time to appropriate acyclovir deescalation.
Main Methods:
- A retrospective single-center cohort study was conducted between February 2017 and April 2019.
- Testing with the ME panel was restricted to patients with suspected meningitis/encephalitis and CSF pleocytosis.
- Positive results were confirmed, and outcomes included utilization rates, negative predictive values, test yield, false-positivity, and time to acyclovir deescalation.
Main Results:
- Restricting ME panel testing to pleocytic CSF samples reduced utilization by 42.7% and increased test yield by 61.8%.
- The negative predictive value of normal CSF white blood cell counts for nonviral ME panel targets was 100%.
- A selective testing algorithm for nonviral targets avoided 75% of false-positive results without generating false negatives, and reduced acyclovir treatment duration.
Conclusions:
- Implementing the FilmArray ME panel with restriction criteria (pleocytosis) and a selective testing algorithm optimizes its utilization, yield, and accuracy.
- Diagnostic stewardship strategies enhance the performance of multiplex PCR panels for infectious disease diagnosis.
- These optimized strategies can lead to more efficient patient management and reduced unnecessary treatment.
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