Article: Association of the FilmArray Meningitis/Encephalitis Panel with Clinical Management
Nabower AM, Miller S, Biewen B, et al. Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management. Hosp Pediatr. 2019;9(10):763-769.
Fellow: Brittany Winckler, MD, MBA; UC San Diego/Rady Children's Hospital San Diego
Summary: PCR to rapidly detect suspected bacterial vs. viral pediatric meningitis could lead to decreased resource utilization. This study compared management practices in patients who had CSF meningitis/encephalitis (ME) panels performed versus those who had CSF cultures with enterovirus and/or HSV PCR. The authors concluded that use of the ME panel led to decreased LOS, time to antibiotic narrowing, and acyclovir dosing. The ME panel’s strengths included a high NPV for bacterial organisms and higher sensitivity for pretreated samples, but discrepant results between the ME panel and standard CSF culture required clinical judgment.
Key Strengths: The demonstration of decreased resources (acyclovir, LOS, antibiotic narrowing) shows the potential utility of the ME panel. The quick turnaround time of the panel seems to be the largest contributor to this decreased utilization. There also seems to be good clinical utility in sending the ME panel on pretreated samples to help with decision-making.
Limitations/Flaws: As PCR panels can be expensive, a cost-benefit analysis would have greatly added to the strength of this study if able to show that, despite the cost of the panel, there was overall benefit in decreased resource utilization. Perhaps an algorithmic approach such as sending an enterovirus PCR (as it typically has a short turnaround time and was the most common viral cause in this study) followed by sending the full ME panel only if the enterovirus PCR is negative would be even more cost-effective than sending the full panel as the first and only test. Another factor that could have influenced the results was the hospital’s concurrent project to discharge low-risk febrile infants in <30h.
Major Takeaway: PCR testing for viral or bacterial meningitis can help reduce resource utilization, but overall cost/benefit is unclear and likely dependent on testing cost and turnaround time. It may be most helpful for HSV/acyclovir use and in clinical decision-making for pretreated CSF cultures.
How should this article impact our practice? Sending a viral and bacterial PCR panel on pretreated CSF samples could help with decision-making in suspected pediatric meningitis. Depending on a hospital’s local resources (availability of PCR testing, cost, and turnaround time), utilization of a PCR test for viral and/or bacterial pathogens may be useful in decreasing acyclovir use, time to narrowing antibiotics, and LOS. However, additional information including a cost-benefit analysis is needed.
Nabower AM, Miller S, Biewen B, et al. Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management. Hosp Pediatr. 2019;9(10):763-769.
Fellow: Brittany Winckler, MD, MBA; UC San Diego/Rady Children's Hospital San Diego
Summary: PCR to rapidly detect suspected bacterial vs. viral pediatric meningitis could lead to decreased resource utilization. This study compared management practices in patients who had CSF meningitis/encephalitis (ME) panels performed versus those who had CSF cultures with enterovirus and/or HSV PCR. The authors concluded that use of the ME panel led to decreased LOS, time to antibiotic narrowing, and acyclovir dosing. The ME panel’s strengths included a high NPV for bacterial organisms and higher sensitivity for pretreated samples, but discrepant results between the ME panel and standard CSF culture required clinical judgment.
Key Strengths: The demonstration of decreased resources (acyclovir, LOS, antibiotic narrowing) shows the potential utility of the ME panel. The quick turnaround time of the panel seems to be the largest contributor to this decreased utilization. There also seems to be good clinical utility in sending the ME panel on pretreated samples to help with decision-making.
Limitations/Flaws: As PCR panels can be expensive, a cost-benefit analysis would have greatly added to the strength of this study if able to show that, despite the cost of the panel, there was overall benefit in decreased resource utilization. Perhaps an algorithmic approach such as sending an enterovirus PCR (as it typically has a short turnaround time and was the most common viral cause in this study) followed by sending the full ME panel only if the enterovirus PCR is negative would be even more cost-effective than sending the full panel as the first and only test. Another factor that could have influenced the results was the hospital’s concurrent project to discharge low-risk febrile infants in <30h.
Major Takeaway: PCR testing for viral or bacterial meningitis can help reduce resource utilization, but overall cost/benefit is unclear and likely dependent on testing cost and turnaround time. It may be most helpful for HSV/acyclovir use and in clinical decision-making for pretreated CSF cultures.
How should this article impact our practice? Sending a viral and bacterial PCR panel on pretreated CSF samples could help with decision-making in suspected pediatric meningitis. Depending on a hospital’s local resources (availability of PCR testing, cost, and turnaround time), utilization of a PCR test for viral and/or bacterial pathogens may be useful in decreasing acyclovir use, time to narrowing antibiotics, and LOS. However, additional information including a cost-benefit analysis is needed.