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Published on: May 19, 2020
Impact of the BioFire FilmArray Meningitis-Encephalitis Panel on Management of Suspected Paediatric Central Nervous
Louisa Mary Churcher1,2, Adam William Bartlett3,4, Stella Pendle5
1Department of Paediatrics, Northern Beaches Hospital, Sydney, New South Wales, Australia.
Background:
Meningoencephalitis causes significant morbidity and mortality in children worldwide. Prompt diagnosis remains challenging, yet advances in molecular diagnostic technology have improved diagnostic performance. This study examined whether the introduction of the BioFire FilmArray meningitis/encephalitis (ME) multiplex panel impacted the diagnosis and management of children with suspected meningoencephalitis.
Methods:
We conducted a retrospective cohort study (January 2019 to July 2021) at a non-tertiary hospital in Sydney, Australia, during which the BioFire ME panel became available. Patients < 16 years who had cerebrospinal fluid (CSF) sampling for investigation of meningoencephalitis were included. Demographic, clinical and microbiological data were extracted to evaluate time to infection diagnosis, antimicrobial rationalisation and duration, investigations undertaken and admission length.
Results:
There were 122 CSF samples collected from children with suspected meningoencephalitis; 70/122 (57.3%) before and 52/122 (42.7%) after BioFire ME panel introduction. Twenty-eight (23.0%) children had BioFire ME testing. Seven bacterial and 27 viral microbiologically confirmed central nervous system (CNS) infections were identified. BioFire ME panel use was associated with faster median confirmation or exclusion of meningoencephalitis (12.6 vs. 48.0 h, p < 0.01, for bacterial and 12.6 vs. 71.5 h, p < 0.01, for viral causes), quicker pathogen identification in viral meningoencephalitis (8.1 vs. 48.7 h, p = 0.019) and earlier antimicrobial rationalisation (24.0 vs. 30.4 h, p < 0.01). Total antimicrobial duration, investigation numbers and hospitalisation duration were not reduced.
Conclusions:
The BioFire ME panel has the potential to reduce the duration of empiric broad-spectrum antimicrobials and their associated adverse effects on children, as well as improve healthcare resource efficiencies.
Insights
The BioFire FilmArray meningitis/encephalitis (ME) panel significantly speeds up diagnosis and antimicrobial adjustment in children with suspected meningoencephalitis. This molecular diagnostic tool improves pathogen identification and reduces time to treatment, enhancing patient care.
Area of Science:
- Pediatric Infectious Diseases
- Molecular Diagnostics
- Clinical Microbiology
Background:
- Meningoencephalitis poses a significant global health burden in children, characterized by challenging diagnostics.
- Advances in molecular diagnostics offer improved accuracy and speed for identifying central nervous system infections.
- This study investigates the impact of a novel multiplex panel on diagnosing pediatric meningoencephalitis.
Purpose of the Study:
- To evaluate the effect of introducing the BioFire FilmArray meningitis/encephalitis (ME) multiplex panel on the diagnosis and management of pediatric meningoencephalitis.
- To assess changes in diagnostic timelines, antimicrobial use, and healthcare resource utilization following panel implementation.
Main Methods:
- A retrospective cohort study was conducted from January 2019 to July 2021, including children under 16 with cerebrospinal fluid sampling for suspected meningoencephalitis.
- Data on demographics, clinical presentation, and microbiological results were collected before and after the BioFire ME panel's introduction.
- Key outcome measures included time to infection diagnosis, pathogen identification, antimicrobial rationalization, and length of hospital stay.
Main Results:
- The BioFire ME panel was used in 28 of 122 cases, significantly reducing the time to confirm or exclude bacterial and viral meningoencephalitis (12.6 vs. 48.0/71.5 hours).
- Quicker pathogen identification in viral cases (8.1 vs. 48.7 hours) and earlier antimicrobial rationalization (24.0 vs. 30.4 hours) were observed with panel use.
- However, total antimicrobial duration, number of investigations, and hospitalisation length did not show significant reductions.
Conclusions:
- The BioFire ME panel demonstrates potential in accelerating the diagnosis of pediatric meningoencephalitis, enabling faster antimicrobial adjustments.
- Early identification of pathogens can lead to reduced use of broad-spectrum antimicrobials, mitigating associated adverse effects.
- Implementation of this molecular diagnostic tool may improve healthcare resource efficiency in managing pediatric CNS infections.
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