The Integration of Multiplex PCR Panel in the Management of Acute Bacterial Meningitis: A Mixed-Methods Study

Meningitis multiplex PCR (MMP) panels are increasingly used in acute bacterial meningitis (ABM), but their clinical integration remains incompletely characterized. We evaluated MMP panel implementation using a mixed-methods approach. We included 55 adults with ABM of confirmed etiology: Group 1 (MMP plus conventional microbiology, n = 25) and Group 2 (conventional methods only, n = 30). The qualitative component comprised semi-structured interviews with infectious disease specialists, analyzed using thematic analysis. Compared with Group 2, Group 1 had a significantly shorter time from lumbar puncture to diagnosis [1.9 (IQR 1.7-2.6) vs. 27.3 (18-47.2) h] and more frequent targeted therapy [19 (76%) vs. 13 (43.3%)]. However, MMP panel use was not associated with antibiotic de-escalation [11 (44%) vs. 12 (40%)], median length of hospitalization (22 days in both groups), median duration of therapy [14 (10-21) vs. 17 (11-22) days], ICU admission [11 (44%) vs. 13 (43.3%)], or mortality [2 (8%) vs. 6 (20%)]. Interviews (n = 20) identified four themes: rapid etiological clarification, perceived limitations, antimicrobial optimization and clinical integration. MMP may facilitate rapid diagnosis, but its impact on outcomes and clinical integration remains limited. Faster availability of etiological information does not necessarily improve antimicrobial decision-making in the absence of antimicrobial stewardship programs.