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Molecular tools for bacterial diagnosis: how, when and why to use them?

Syndromic tests for meningitis: patient screening before testing allows a high efficient medical value

April 20 • O0888

O. Dauwalder1/2, JS. Casalegno1/2, L. Chelghoum1, B. Visseaux3, CA. Gustave1, D. Dupont1, P. Girardo1, H. Salord1/2, M. Bouscambert-Duchamp1/2, G. Billaud1/2, MP. Milon1, G. Lina1, F. Morfin1/2, F. Laurent2, M. Wallon1, D. Descamps3, B. Lina2, F. Vandenesch1/2

1) Hospices Civils De Lyon - Hcl, Plateau de Microbiologie 24/24 - Centre de Biologie et Pathologie Nord, Lyon, France
2) Hospices Civils De Lyon - Hcl, Plateau de Microbiologie Moléculaire - Centre de Biologie et Pathologie Nord, Lyon, France
3) Bichat-Claude Bernard Hospital, Laboratoire de Virologie, Paris, France

Background: Evaluation of the impact of the syndromic molecular test BIOFIRE® FILMARRAY® Meningitis / Meningoencephalitis (BIOFIRE FILMARRAY ME Panel, bioMérieux) on the diagnosis, the anti-infectious therapy, the para-clinical examinations, the isolation and the project of care of the patient.

Materials/methods: Prospective single-center study (2017-2019) on 149 patients (86♂, 63 ♀ – mean age 29 years) admitted to the emergency room or intensive care units (pediatric and adult) or in infectious clinical ward for a suspected community-acquired meningitis / meningoencephalitis (MME) and with CSF with more than 9 leukocytes/μL. The BIOFIRE FILMARRAY ME Panel was produced 24 hours on 7 and a standardized survey of 44 questions was filled during the telephone communication of the BIOFIRE FILMARRAY ME Panel results to the clinicians by the medical biology student (MS Form).

Results: Of 149 patients, 57 and 65 were suspected of bacterial and viral meningitis respectively, and 68 patients had a positive BIOFIRE FILMARRAY ME Panel (45%): enterovirus (36), VZV (10), HSV (8), N. meningitidis (3), Streptococcus pneumoniae (3), S. agalactiae (3), Listeria (2), H. influenzae (2). BIOFIRE FILMARRAY ME Panel was delivered in 57% and 32% of cases in less than 4 and 8 hours after CSF sampling respectively. 47 and 97 patients were on anti-infectious drugs respectively before and after CSF puncture. In 43%, the BIOFIRE FILMARRAY ME Panel help to establish the final diagnosis of meningitis/encephalitis and in 27% to exclude it. BIOFIRE FILMARRAY ME Panel modify isolation status for 19% of patients and the care project in 63% of cases with only 7% of “go back home”. Antibiotic therapy was affected (addition, discontinuation, modification) by the BIOFIRE FILMARRAY ME Panel in 34% of patients against 23% for antivirals. Finally, in 12 and 8% of cases, the BIOFIRE FILMARRAY ME Panel helped to cancel or add additional exams.

Conclusions: Screened according to clinic and biological restrictive criteria, carried out 24 hours a day according to an “emergency” pre-analytical workflow and systematically associated with stewardship, the BIOFIRE® FILMARRAY® ME Panel shows a high positivity rate associated with therapeutic, para-clinical and multiple organizational impacts demonstrating the high medical value of this syndromic molecular test in an emergency context.

filmarray

ME Panel

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