Implementation of the BIOFIRE Meningitis/Encephalitis Panel: A Mixed-Methods Implementation Study in a
Shradha Subedi1,2, N A Patrick Harris1,3, Lisa Hall4
1University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
Background:
Meningitis and encephalitis (ME) are associated with significant morbidity and mortality. Rapid pathogen identification is essential to guide early treatment and support antimicrobial stewardship (AMS). The BIOFIRE® FILMARRAY® ME panel allows simultaneous detection of multiple pathogens from cerebrospinal fluid. This study evaluated the implementation strategy and clinician adoption of the panel in a large nonmetropolitan tertiary hospital in Australia.
Method:
A mixed-methods study was conducted at the Sunshine Coast University Hospital following implementation of the BIOFIRE ME panel. Strategies included education sessions, testing criteria development, and continuous stakeholder engagement. Clinician knowledge, confidence, and antimicrobial decision-making practices were assessed at baseline and during implementation via surveys and semistructured interviews based on the Cabana et al conceptual framework. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed thematically using Braun and Clarke's 5 step process.
Results:
A total of 213 clinicians participated in the surveys across 4 time points. Median perceived usefulness of rapid CSF PCR testing was 9/10. Confidence in ceasing antibiotics based on the assay results increased from 18% at 9 months to 52% at 12 months (P = .06), while confidence in ceasing antivirals remained high (85%-86%). Qualitative findings identified 5 themes influencing implementation: test-ordering practices, perceived diagnostic value, trust in results, antimicrobial stewardship, and behavioral change. Confidence in interpretation was highest where infectious diseases input was available.
Conclusions:
Implementation of the syndromic panel improved diagnostic efficiency and clinician confidence in antimicrobial decision making. Sustained education, multidisciplinary collaboration, and integration of stewardship frameworks were key to achieving successful adoption.
