Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy

Suspected meningitis/encephalitis cases require prompt empirical antimicrobial therapy. Syndromic diagnostics like the FilmArray Meningitis/Encephalitis (FAME) panel offer rapid results and are increasingly used despite high costs. This study assessed FAME's integration in clinical microbiology laboratories' everyday practice and its impact on early treatment decisions. The FilmArray Meningitis/encephalitis panel Outcome Study (FAMOuS) retrospectively reviewed biological data, treatments before/after FAME, and outcomes from 783 patients across six French hospitals over a 3-year period. FAME results were 80% negative, 7% bacterial, and 13% viral, with no bacterial false negatives. Positive results in samples with <10 leukocytes were exclusively seen in immunocompromised individuals and children under 2. Positive results prompted therapeutic changes in 74% of cases, compared to 50% for negatives. FAMOuS enabled the proposal of a decision-support flowchart to optimize the rational use of FAME and support antibiotic stewardship, with the potential to increase early antibiotic discontinuation and reduce unnecessary testing.IMPORTANCEPrompt identification of infectious causes is essential in suspected meningitis and encephalitis, where timely treatment decisions can be lifesaving. The FAMOuS study evaluated the use of the FilmArray Meningitis/Encephalitis (FAME) panel across six French hospitals, analyzing nearly 800 patient episodes. The findings demonstrate that FAME offers reliable results that directly influence clinical management-guiding therapeutic adjustments in most positive cases and supporting early antibiotic discontinuation when appropriate. The study highlights specific patient contexts where FAME provides the greatest clinical value and proposes a decision-support flowchart to optimize its rational use. By integrating rapid molecular diagnostics into everyday practice, this work contributes to improved patient care and reinforces hospital antibiotic stewardship strategies.