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Impact of Multiplex Polymerase Chain Reaction Test in Patients With Meningitis or Encephalitis

Daisuke Kitagawa1,2, Taito Kitano3, Yuto Uchihara4

  • 1Department of Laboratory Medicine, Nara Prefecture General Medical Center, Nara, Japan.

Open Forum Infectious Diseases
|December 29, 2023
PubMed
Abstract

Insights

The FilmArray meningitis/encephalitis (FAME) panel significantly reduced antiviral treatment duration in Japanese hospitals. However, length of stay and antibacterial use remained unchanged, necessitating further evaluation of FAME

Area of Science:

  • Clinical microbiology
  • Infectious diseases
  • Hospital epidemiology

Background:

  • The FilmArray meningitis/encephalitis (FAME) panel is a multiplex nucleic acid test used for diagnosing central nervous system infections.
  • Evaluating the clinical and economic impact of diagnostic panels like FAME is crucial for optimizing patient care and resource allocation in hospitals.

Purpose of the Study:

  • To assess the impact of implementing the FAME panel on length of stay (LOS) and duration of antimicrobial treatment in pediatric and adult patients.
  • To analyze changes in diagnostic practices and pathogen identification rates following FAME panel adoption.

Main Methods:

  • A retrospective cohort study was conducted in a Japanese community hospital from January 2016 to December 2022.
  • Patients with cerebrospinal fluid (CSF) samples were included, with specific criteria for infants (<2 months) and those with elevated white blood cell counts (≥5/μL).
  • Multivariate Poisson regression analyses were used to compare days of therapy (DOT) and LOS between the pre-FAME and FAME implementation periods.

Main Results:

  • Pathogen-specific polymerase chain reaction (PCR) use increased significantly from 3.7% to 57.5% (P < .001) after FAME implementation.
  • The overall pathogen identification rate rose from 0.4% to 18.7% (P < .001).
  • While antibacterial DOT showed no significant difference (aRR, 1.06; P = .063), antiviral DOT was significantly reduced in the FAME period (aRR, 0.80; P < .001).

Conclusions:

  • The FAME panel led to a significant decrease in antiviral treatment duration but did not impact LOS or antibacterial use.
  • External factors, such as the COVID-19 pandemic, may have influenced meningitis and encephalitis epidemiology, confounding the observed results.
  • Continuous monitoring of FAME's clinical impact and the epidemiology of meningitis/encephalitis is recommended to refine its appropriate use.
Keywords:
FilmArrayantibacterialantiviraldays of therapymeningitis

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