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The FilmArray® Meningitis/Encephalitis Panel (MEP) is a rapid multiplex assay that tests cerebrospinal fluid (CSF) for 14 common central nervous system (CNS) pathogens, with results available in hours as opposed to days with the gold standard CSF culture. Current literature on the impact of MEP testing on length of stay (LOS) and antimicrobial use in pediatric patients is from only single site studies with variable results.
MEP testing in pediatric patients would be associated with a decreased LOS, time on IV antibiotics, and time to narrowing antibiotics.
We conducted a retrospective study of 5 sites. Inclusion criteria were children 0-18 years with lumbar puncture (LP) performed within 48 hours of presentation for suspected CNS infection between January 2015 and February 2019. Children with a neurosurgical history or immunosuppression were excluded. Collected data included demographics, presenting clinical features, laboratory and radiographic findings, antimicrobial use, and clinical outcomes. Mann-Whitney and Fisher’s exact test were used to compare continuous variables and categorical variables, respectively. A linear mixed model was used to analyze the effect of the MEP on LOS adjusting for clinical site, age, antibiotic pretreated LP, highest level of care, positive body fluid culture, CSF white blood cell count, and brain imaging consistent with meningitis/encephalitis.
This study included 2,436 children, 833 received MEP testing. Patients in the MEP group were more likely to be younger, receive ICU level care, be unimmunized, have neurological symptoms at presentation, have a higher median CSF WBC count, or have received antibiotic treatment prior to LP (p=0.002, p<0.0001, p<0.0001, p<0.0001, p<0.0001, p=0.03, p<0.0001). Patients in the MEP group were more likely to have abnormal head imaging, an infectious diseases consult, or a PICC line placed (p<0.0001). In the univariate analysis the MEP group had a longer median LOS and this difference persisted after adjusting for the seven covariates (p<0.0001, p=0.0017). There was no statistically significant difference in median total IV antibiotic time or median time to narrowing antibiotics (p=0.12, p=0.33).
Contrary to our hypothesis we found that patients who had MEP testing performed had a longer LOS, despite no difference being noted in the duration of IV antibiotics and time to narrowing antibiotics. Further analysis is needed to identify clinical scenarios in which MEP testing is most effective.
Chatterton, John; Nabower, Aleisha; Gollehon, Nathan; Goodrich, Nathaniel; Rajbhandari, Prabi; Eisenberg, Jaclyn; Martin, Kimberly; Woslager, Megan; Ekambaran, Maheswari; Ampofo, Krow; Lyden, Elizabeth; and Snowden, Jessica, "Impact of the Filmarray® Meningitis/Encephalitis Panel On Clinical Practice In Pediatrics; A Multicentered Study" (2022). Child Health Research Institute Pediatric Research Forum. 41.