Background: Infectious meningitis and meningo-encephalitis are life-threatening conditions associated with high morbidity and mortality. In emergency departments, their diagnoses are still a challenge for the clinician since pleiocytosis is not specific of infectious meningitis. Recently, multiplex PCRs have been developed to improve this diagnosis and optimize patient management and treatment. The objective of this study was to measure the impact of multiplex PCR in the management of viral meningitis.
Materials/methods: We conducted a retrospective monocentric study in the Emergency department of our University hospital including all patients who underwent lumbar puncture with pleocytosis (> 5 leukocytes / mm3). The study was divided into two periods: Period 1 from April 2014 to March 2017 before the implementation of the BIOFIRE® FILMARRAY® ME test (bioMérieux) and Period 2 from April 2017 to March 2019 after implementation. Microbiological and clinical data of patients were collected from hospital informative systems.
Results: Out of 7,674 CSF (7,341 patients) analyzed, 1,121 (15.3% patients) showed pleocytosis (587 in Period 1 and 534 in Period 2). Meningitis or meningo-encephalitis were diagnosed in more cases in Period 2 than in Period 1 (325 [60.9%] vs. 312 [53.2%], respectively (p=0.009)). The proportion of pathogens identified among those covered by the BIOFIRE® FILMARRAY® ME test was not significantly different between period 1 and period 2 ((127/312, 40.7% vs. 153/325, 47.1%, p=0.1). For the subgroup of Enteroviral (EV) meningitis, patients were less often hospitalized in Period 2 than in Period 1 (38/58 65.5% vs 32/88 36.4%, p<0.001), and the duration of hospitalization for patients with EV or HSV-2 meningitis was significantly shorter (mean duration of 1.63 days vs 2.54 for EV and 3.6 days vs 6.6 for HSV-2, p<0.001 and p=0.01 respectively). Empirical prescription of acyclovir was reduced during Period 2 for patients with EV (10/58 vs 6/88, p=0.05) or VZV meningitis (20/25 vs 7/18, p=0.01). In addition, the prescription of antibiotics was reduced in Period 2 for patients with HSV-2 meningitis (4/9 vs 0/25, p=0.002).
Conclusion: The implementation of a rapid multiplex PCR in the diagnosis of community meningitis in emergencies appears to have an impact on the management of viral meningitis and may reduce inadequate antimicrobial treatments.