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How do we reduce acyclovir overuse? Impact of FilmArray meningitis/encephalitis panel tests for pediatric patients
Shogo Otake1, Yui Nakagawa2, Hayato Ryu2
1Division of Infectious Disease, Department of Pediatrics, Kobe Children's Hospital, Hyogo, Japan.
Background:
Few Japanese hospitals can perform in-house cerebrospinal fluid (CSF) polymerase chain reaction (PCR) to screen for herpes simplex virus, leading to patients being administered acyclovir (ACV) for several days. The FilmArray Meningitis/Encephalitis Panel (ME Panel) is a multiplex PCR test that can identify 14 major pathogens within 1 h. We aimed to investigate the efficacy of the ME Panel in children admitted with central nervous system infections in Japan.
Methods:
We conducted a single-center, quasi-experimental study. The ME panel was introduced in April 2020. We outsourced the CSF samples to a laboratory during the pre-intervention period (April 2016 to March 2020) and performed the ME panel at our hospital during the post-intervention period (April 2020 to December 2021). Duration and dose of ACV and antibiotic use, length of stay (LOS) in the pediatric intensive care unit (PICU), and total LOS after testing were compared using the Mann-Whitney U test.
Results:
The number of cases in the pre- and post-intervention periods was 67 and 22 cases, respectively. The median duration of ACV decreased significantly from 6 days to 0 day (p < 0.001), and the median dose of ACV use decreased significantly from 14 vials to 0 vial (p < 0.001). No significant differences were noted in the total duration and dose of antibiotic use, LOS in PICU, and the total LOS after testing.
Conclusion:
The introduction of ME panel may contribute to appropriate ACV use; however, there was no significant change in the duration and dose of antibiotic use or LOS.
Insights
The FilmArray Meningitis/Encephalitis Panel significantly reduced acyclovir use in children with central nervous system infections. However, it did not impact antibiotic use or hospital length of stay.
Area of Science:
- Infectious Diseases
- Clinical Diagnostics
- Pediatrics
Background:
- Limited in-house cerebrospinal fluid (CSF) polymerase chain reaction (PCR) testing for herpes simplex virus in Japanese hospitals leads to prolonged acyclovir (ACV) administration.
- The FilmArray Meningitis/Encephalitis (ME) Panel offers rapid multiplex PCR identification of 14 pathogens within an hour.
Purpose of the Study:
- To evaluate the efficacy of the ME Panel in Japanese children diagnosed with central nervous system infections.
- To assess the impact of the ME Panel on acyclovir and antibiotic usage, and patient length of stay.
Main Methods:
- A single-center, quasi-experimental study comparing pre-intervention (outsourced CSF testing) and post-intervention (in-house ME Panel) periods (April 2016 - December 2021).
- Comparison of acyclovir and antibiotic duration/dose, pediatric intensive care unit (PICU) length of stay (LOS), and total LOS using Mann-Whitney U test.
Main Results:
- A significant decrease in median ACV duration (6 days to 0 day) and dose (14 vials to 0 vial) was observed post-ME Panel introduction (p < 0.001).
- No significant differences were found in total antibiotic use, PICU LOS, or overall LOS after testing.
Conclusions:
- Implementation of the ME Panel facilitates appropriate acyclovir use in pediatric central nervous system infections.
- The ME Panel did not significantly alter antibiotic treatment duration or overall patient length of stay.
