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Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System
Kevin Messacar1, Claire Palmer2, LiseAnne Gregoire3
1Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO.
Objective:
To investigate the optimal implementation and clinical and financial impacts of the FilmArray Meningitis Encephalitis Panel (MEP) multiplex polymerase chain reaction testing of cerebrospinal fluid (CSF) in children with suspected central nervous system infection.
Study Design:
A pre-post quasiexperimental cohort study to investigate the impact of implementing MEP using a rapid CSF diagnostic stewardship program was conducted at Children's Hospital Colorado (CHCO). MEP was implemented with electronic medical record indication selection to guide testing to children meeting approved use criteria: infants <2 months, immunocompromised, encephalitis, and ≥5 white blood cells/μL of CSF. Positive results were communicated with antimicrobial stewardship real-time decision support. All cases with CSF obtained by lumbar puncture sent to the CHCO microbiology laboratory meeting any of the 4 aforementioned criteria were included with preimplementation controls (2015-2016) compared with postimplementation cases (2017-2018). Primary outcome was time-to-optimal antimicrobials compared using log-rank test with Kaplan-Meier analysis.
Results:
Time-to-optimal antimicrobials decreased from 28 hours among 1124 preimplementation controls to 18 hours (P < .0001) among 1127 postimplementation cases (72% with MEP testing conducted). Postimplementation, time-to-positive CSF results was faster (4.8 vs 9.6 hours, P < .0001), intravenous antimicrobial duration was shorter (24 vs 36 hours, P = .004), with infectious neurologic diagnoses more frequently identified (15% vs 10%, P = .03). There were no differences in time-to-effective antimicrobials, hospital admissions, antimicrobial starts, or length of stay. Costs of microbiologic testing increased, but total hospital costs were unchanged.
Conclusions:
Implementation of MEP with a rapid central nervous system diagnostic stewardship program improved antimicrobial use with faster results shortening empiric therapy. Routine MEP testing for high-yield indications enables antimicrobial optimization with unchanged overall costs.
Insights
Implementing the FilmArray Meningitis Encephalitis Panel (MEP) with diagnostic stewardship significantly reduced time to optimal antimicrobials for children with suspected central nervous system infections. This approach improved antimicrobial use and diagnostic speed without increasing overall hospital costs.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Pediatric Neurology
Background:
- Central nervous system infections in children require rapid diagnosis and appropriate antimicrobial treatment.
- The FilmArray Meningitis Encephalitis Panel (MEP) offers multiplex polymerase chain reaction (PCR) testing for cerebrospinal fluid (CSF).
- Optimizing the implementation of advanced diagnostic tools like MEP is crucial for improving patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the clinical and financial impacts of implementing the FilmArray Meningitis Encephalitis Panel (MEP) in children with suspected central nervous system infections.
- To assess the effectiveness of a rapid CSF diagnostic stewardship program integrated with MEP testing.
- To determine if MEP implementation influences antimicrobial prescribing patterns and patient outcomes.
Main Methods:
- A pre-post quasiexperimental cohort study design was employed at Children's Hospital Colorado.
- MEP testing was guided by electronic medical record indications for high-yield pediatric populations.
- Antimicrobial stewardship provided real-time decision support for positive MEP results, comparing preimplementation (2015-2016) and postimplementation (2017-2018) cohorts.
Main Results:
- Time to optimal antimicrobials decreased significantly from 28 to 18 hours post-MEP implementation (P < .0001).
- Time to positive CSF results was faster (4.8 vs 9.6 hours, P < .0001), and intravenous antimicrobial duration was shorter (24 vs 36 hours, P = .004).
- Infectious neurologic diagnoses were identified more frequently (15% vs 10%, P = .03), with no significant changes in overall hospital costs.
Conclusions:
- MEP implementation, coupled with a diagnostic stewardship program, enhances antimicrobial use and diagnostic efficiency in pediatric CNS infections.
- Targeted MEP testing for high-yield indications optimizes antimicrobial therapy and leads to faster results.
- This integrated approach achieves improved clinical outcomes with stable overall hospital expenditures.
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