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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.
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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