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Evaluating the Impact of the BioFire FilmArray in Childhood Meningitis: An Observational Cohort Study
Seilesh Kadambari1,2,3, Shuo Feng1, Xinxue Liu1
1From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.
Background:
Multiplex polymerase chain reaction assays have the potential to reduce antibiotic use and shorten length of inpatient stay in children with suspected central nervous system infection by obtaining an early microbiological diagnosis. The clinical impact of the implementation of the BioFire FilmArray Meningitis/Encephalitis Panel on the management of childhood meningitis was evaluated at the John Radcliffe Hospital in Oxford and Children's Health Ireland at Temple Street in Dublin.
Methods:
Children who had lumbar punctures performed as part of a septic screen were identified retrospectively through clinical discharge coding and microbiology databases from April 2017 to December 2018. Anonymized clinical and laboratory data were collected. Comparison of antibiotic use, length of stay and outcome at discharge was made with a historical cohort in Oxford (2012-2016), presenting before implementation of the FilmArray.
Results:
The study included 460 children who had a lumbar puncture as part of an evaluation for suspected central nervous system infection. Twelve bacterial cases were identified on the FilmArray that were not detected by conventional bacterial culture. Bacterial culture identified one additional case of bacterial meningitis, caused by Escherichia coli , which had not been identified on the FilmArray. Duration of antibiotics was shorter in children when FilmArray was used than before its implementation; enterovirus meningitis (median: 4 vs. 5 days), human parechovirus meningitis (median: 4 vs. 4.5 days) and culture/FilmArray-negative cerebrospinal fluid (median: 4 vs. 6 days).
Conclusions:
The use of a FilmArray can identify additional bacterial cases of meningitis in children that had been negative by traditional culture methods. Children with viral meningitis and culture-negative meningitis received shorter courses of antibiotics and had shorter hospital stays when FilmArray was used. Large studies to evaluate the clinical impact and cost effectiveness of incorporating the FilmArray into routine testing are warranted.
Insights
The BioFire FilmArray Meningitis/Encephalitis Panel improved early diagnosis of central nervous system infections in children. This led to reduced antibiotic use and shorter hospital stays for those with viral or culture-negative meningitis.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Molecular Diagnostics
Background:
- Multiplex PCR assays offer early microbiological diagnosis for suspected central nervous system infections in children.
- This can potentially reduce antibiotic use and length of hospital stay.
- The BioFire FilmArray Meningitis/Encephalitis Panel's clinical impact on childhood meningitis management was evaluated.
Purpose of the Study:
- To evaluate the clinical impact of the BioFire FilmArray Meningitis/Encephalitis Panel on childhood meningitis management.
- To compare antibiotic use, length of stay, and patient outcomes before and after FilmArray implementation.
Main Methods:
- Retrospective analysis of children undergoing lumbar puncture for suspected central nervous system infection (April 2017 - December 2018).
- Data collected included anonymized clinical and laboratory information.
- Comparison with a historical cohort (2012-2016) prior to FilmArray implementation.
Main Results:
- The FilmArray identified 12 additional bacterial meningitis cases missed by conventional culture.
- Conventional culture identified one case (Escherichia coli) missed by FilmArray.
- Shorter antibiotic durations were observed with FilmArray use: enterovirus (4 vs. 5 days), human parechovirus (4 vs. 4.5 days), and culture/FilmArray-negative CSF (4 vs. 6 days).
Conclusions:
- The FilmArray enhances detection of bacterial meningitis cases compared to traditional culture.
- Children with viral or culture-negative meningitis experienced shorter antibiotic courses and hospital stays with FilmArray use.
- Further large-scale studies are needed to assess the clinical impact and cost-effectiveness of routine FilmArray integration.
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