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Published on: March 14, 2016
Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel - a retrospective study to
Andrea Erba1, Fabian C Franzeck2, Vladimira Hinic3,4
1Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Background:
The Biofire® FilmArray® Meningitis/Encephalitis (ME) PCR panel covers 14 viral, bacterial, and fungal pathogens and has been implemented in many institutions worldwide. Post-marketing studies indicate a reduced sensitivity and overutilization underscoring the need for a more targeted usage. The aim of our study is to describe the utilization of the ME panel and to develop a diagnostic-stewardship based decision rule.
Materials:
Adult patients, who underwent CSF analysis with the ME panel between August 2016 and June 2021 at the University Hospital Basel, were included. Demographic, clinical, microbiological, and laboratory data were extracted from the electronic health record. Factors associated with a positive ME panel result were identified, and a decision rule was developed to potentially optimize the diagnostic yield and reduce the number of unnecessary tests.
Results:
1,236 adult patients received at least one panel in the observed period, of whom 106 panels tested positive (8.6%). The most frequently observed pathogens were Varicella Zoster Virus (VZV, 27%), Streptococcus pneumoniae (19%), Enterovirus (16%), Herpes simplex Virus 1/2 (16%), and Human Herpesvirus 6 (HHV-6, 13%). Fever, vomiting, headache, and photophobia were more frequently present in test positive patients as were significantly higher CSF leukocytes and protein concentrations. When simulating a decision rule based on CSF leukocytes and protein concentration, only 35% of all patients would have qualified for a ME panel tests, thereby increasing the positivity rate to 22.7%. 10 of 106 positive ME panels would have been missed, only involving HHV-6 and VZV (6 and 4 cases, respectively). As these subjects were either severely immunocompromised or had clinical features of shingles we propose extending the testing algorithm by including those criteria.
Conclusion:
The ME panel positivity rate at our institution was similar as previously published. Our results highlight the need for diagnostic-stewardship interventions when utilizing this assay by implementing a stepwise approach based on a limited number of clinical and laboratory features. This decision rule may improve the pretest probability of a positive test result, increase the quality of test utilization, and reduce costs.
Insights
The Biofire FilmArray Meningitis/Encephalitis (ME) panel is overutilized. A new decision rule based on CSF leukocytes and protein could improve diagnostic yield and reduce unnecessary ME panel tests.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Diagnostic Stewardship
Background:
- The Biofire FilmArray Meningitis/Encephalitis (ME) PCR panel is widely used for detecting 14 pathogens.
- Post-marketing data suggests reduced sensitivity and overutilization of the ME panel.
- There is a need for more targeted usage of the ME panel.
Purpose of the Study:
- To describe the utilization patterns of the ME panel in adult patients.
- To develop a diagnostic-stewardship based decision rule for ME panel testing.
- To optimize diagnostic yield and reduce unnecessary tests.
Main Methods:
- Retrospective analysis of adult patients undergoing CSF analysis with the ME panel (August 2016 - June 2021).
- Extraction of demographic, clinical, microbiological, and laboratory data from electronic health records.
- Identification of factors associated with positive ME panel results and development of a decision rule.
Main Results:
- 1,236 adult patients received the ME panel; 8.6% tested positive.
- Common pathogens: Varicella Zoster Virus (27%), Streptococcus pneumoniae (19%), Enterovirus (16%).
- A simulated decision rule (CSF leukocytes and protein) would have reduced testing to 35% of patients, increasing positivity to 22.7%, missing 10 cases (HHV-6, VZV).
Conclusions:
- The ME panel positivity rate in this study aligns with previous publications.
- Diagnostic stewardship interventions, including a stepwise approach based on clinical and laboratory features, are necessary.
- The proposed decision rule can enhance pretest probability, improve test utilization quality, and reduce costs.
