Efficient use of the BioFire® FilmArray® Meningitis/Encephalitis Panel: a diagnostic stewardship approach

Area of Science:

• Clinical Microbiology
• Infectious Diseases
• Diagnostic Assay Evaluation

Background:

• The BioFire® FilmArray® Meningitis/Encephalitis Panel (FA/ME) is a multiplex PCR assay for detecting community-acquired meningitis/encephalitis pathogens.
• Optimizing the use of advanced diagnostic tools like FA/ME is crucial for effective patient management and resource allocation.

Purpose of the Study:

• To evaluate the performance and clinical impact of the FA/ME panel in an Australian tertiary hospital.
• To assess the potential of a diagnostic stewardship algorithm to optimize FA/ME utilization.

Main Methods:

• Retrospective analysis of microbiological and clinical data from 712 patients tested with FA/ME.
• Evaluation of a diagnostic stewardship algorithm incorporating cerebrospinal fluid white cell count (WCC) thresholds.

Main Results:

• The FA/ME panel demonstrated 69.70% sensitivity and 93.04% specificity.
• FA/ME positivity was linked to targeted antimicrobial therapy and reduced hospital stays.
• Cerebrospinal fluid white cell count (WCC) >50 × 10^6/L strongly predicted FA/ME positivity (AUC=0.80).

Conclusions:

• A stewardship algorithm using a WCC threshold of >50 × 10^6/L for FA/ME testing, with reflex testing for lower WCC, could significantly reduce costs.
• This strategy would double the positivity rate to 29.54% and ensure detection of all clinically significant infections.
• Optimized FA/ME use in Australia can improve patient management and healthcare efficiency.