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Efficient use of the BioFire® FilmArray® Meningitis/Encephalitis Panel: a diagnostic stewardship approach
Nalian H Ibrahim1,2, Paul Kinsella2,3, Eddie Chan2,3
1Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Background:
The BioFire® FilmArray® Meningitis/Encephalitis Panel (FA/ME) (BioFire Diagnostics, LLC, Salt Lake City, UT, USA) is a multiplex polymerase chain reaction (PCR) assay which detects pathogens causing community-acquired meningitis/encephalitis.
Aims:
This study aimed to evaluate the performance, clinical impact and potential of a diagnostic stewardship algorithm to optimise FA/ME use in an Australian tertiary hospital.
Methods:
This retrospective study evaluated microbiological data from 712 patients who underwent FA/ME testing between July 2018 and April 2024 at the Royal Melbourne Hospital and clinical data from a subset of 439 patients.
Results:
The FA/ME positivity rate was 12.2%. The panel showed 69.70% sensitivity and 93.04% specificity compared with comparator methods. FA/ME positivity was associated with targeted antimicrobial therapy and shorter hospital stays. The cerebrospinal fluid white cell count (WCC) strongly predicted FA/ME positivity (area under the curve = 0.80, P < 0.0001).
Conclusions:
A diagnostic stewardship algorithm employing a WCC threshold of >50 × 106/L for FA/ME testing, with reflex testing of specimens with lower WCC on an alternative viral multiplex PCR, would have reduced annual costs from $23 302 (without stewardship) to $14 646, doubled the positivity rate to 29.54% and detected all clinically significant infections. This study provides insights into optimising FA/ME use in Australia to improve patient management.
Insights
Implementing a diagnostic stewardship algorithm for the BioFire® FilmArray® Meningitis/Encephalitis Panel (FA/ME) can optimize its use. This approach enhances test positivity and clinical outcomes while reducing healthcare costs in Australian hospitals.
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.
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