Fellow: Courtney Charvat, Emory University / Children’s Healthcare of Atlanta
Article: O’Brien, MP, Francis, JR, Marr, IM, Baird, RW. Impact of Cerebrospinal Fluid Multiplex Assay on Diagnosis and Outcomes of Central Nervous System Infections in Children. The Pediatric Infectious Disease Journal 2018; 37(9): 868-871.
Summary: This cohort study in Australia compared time to organism identification and antibiotic management of 0-16 year olds with CNS infections in the 15-months before and 15-months after the introduction of the CSF BioFire multiplex assay. Thirty-six cases of CNS infection were diagnosed prior to the assay and 29 afterwards; only viral etiologies (primarily Enterovirus and Parechovirus) were identified by the assay. After introduction of the molecular assay, there were significant reductions in time to organism identification (6 to 2 days), duration of antibiotics (3 to 2 days), and length of hospitalization (5 to 3 days).
Key Strengths: The article clearly defines suspected and confirmed CNS infection and provides detailed chart review on any discordant results. The authors also confirmed test results using a reference lab and found sensitivity and specificity similar to previous studies.
Key Limitations: This was a single center study with a small sample size. The study did not have sufficient case numbers to comment on the accuracy or utility of the multiplex assay in the diagnosis of bacterial CNS infections. In fact, no bacterial pathogens were identified by multiplex assay. They also did not comment on whether there were any differences in characteristics or outcomes between the groups.
Major Takeaway: CSF BioFire multiplex assay can quickly identify many CNS infections. Identification of a viral etiology can shorter duration of antibiotics and hospital length of stay.
How this article should impact our practice: This study further adds to the small, but growing, body of literature supporting discontinuation of antibiotics after identification of a viral etiology of CNS infection.
Article: O’Brien, MP, Francis, JR, Marr, IM, Baird, RW. Impact of Cerebrospinal Fluid Multiplex Assay on Diagnosis and Outcomes of Central Nervous System Infections in Children. The Pediatric Infectious Disease Journal 2018; 37(9): 868-871.
Summary: This cohort study in Australia compared time to organism identification and antibiotic management of 0-16 year olds with CNS infections in the 15-months before and 15-months after the introduction of the CSF BioFire multiplex assay. Thirty-six cases of CNS infection were diagnosed prior to the assay and 29 afterwards; only viral etiologies (primarily Enterovirus and Parechovirus) were identified by the assay. After introduction of the molecular assay, there were significant reductions in time to organism identification (6 to 2 days), duration of antibiotics (3 to 2 days), and length of hospitalization (5 to 3 days).
Key Strengths: The article clearly defines suspected and confirmed CNS infection and provides detailed chart review on any discordant results. The authors also confirmed test results using a reference lab and found sensitivity and specificity similar to previous studies.
Key Limitations: This was a single center study with a small sample size. The study did not have sufficient case numbers to comment on the accuracy or utility of the multiplex assay in the diagnosis of bacterial CNS infections. In fact, no bacterial pathogens were identified by multiplex assay. They also did not comment on whether there were any differences in characteristics or outcomes between the groups.
Major Takeaway: CSF BioFire multiplex assay can quickly identify many CNS infections. Identification of a viral etiology can shorter duration of antibiotics and hospital length of stay.
How this article should impact our practice: This study further adds to the small, but growing, body of literature supporting discontinuation of antibiotics after identification of a viral etiology of CNS infection.