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Central nervous system infections

Clinical utility of syndromic meningitis/encephalitis testing in children

May 18 • P0220

R. Yee1, U. Pandey1, C. Holifield1, J. Flores1, M. Fahit1, S. Naccache2, J. Dien Bard1

1) Children’s Hospital Los Angeles, Los Angeles, CA, USA
2) LabCorp Diagnostic Laboratories, Seattle, USA

Background: Rapid diagnosis and treatment of central nervous system infections is critical. The BIOFIRE® Meningitis/Encephalitis (ME) Panel is a molecular syndromic test that can rapidly detect 14 pathogens in cerebrospinal fluid (CSF). Here, we sought to analyze the clinical utilization and impact of ME Panel in children.

Materials/methods: Between June 2016-December 2017, ME Panel was tested on 449 patients (Test group) and 412 patients received no ME Panel testing (Control group). Chart abstraction was conducted to compare patient medical history, antimicrobial course, and length of stay (LOS).

Results: ME Panel testing in the Test group detected 62/449 (14%; 14 bacteria, 48 virus) targets compared to 8/412 (2%; 5 bacteria, 3 virus) in the Control group. The top three most common targets detected by ME Panel were Enterovirus (n=25), HHV-6 (n=14), and Streptococcus agalactiae (n=7). The number of immunocompetent patients were slightly lower in the Test group compared to Control (57.9% vs 66.5%). The median time to discontinuation (TTD) of key antibiotics in patients with negative test results was shorter by 21.8 hours (32.7 vs 54.5 hrs, P=0.0002) in Test group. These drugs include gentamicin (32.2 vs 54.4hrs, P=0.03), ampicillin (34.4 vs 54.4 hrs, P=0.0002), cefepime (28.9 vs 55 hrs, P=0.002), and meropenem (154 vs 215 hrs, P=0.52). For a positive viral result, the median TTD of antibiotics in the Test group was 34.7 hours from time of test ordered. Results were not compared to Control group due to the low number of viral positives. Patients previously not placed on antibiotic therapy but tested positive for bacterial target were started on appropriate antibiotics 69 hours earlier in the Test group (14.5 vs 83.5 hrs, P=0.2). Rapid ME Panel results in the Test group resulted in a decrease in LOS by 4 days (2.7 vs 6.7 days, P<0.001) in positive patients. In the Test group, patients positive for viral targets were discharged 11.2 days (2.6 vs 13.8 days, P=0.002) earlier than those positive for bacterial targets.

Conclusions: ME Panel significantly reduced time to identification of M/E pathogens. Use of BIOFIRE® Meningitis/Encephalitis (ME) Panel was associated with accelerated optimization of therapy and decreased LOS in pediatric patients.

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ME Panel

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