For a study, researchers sought to determine the best way to implement the FilmArray Meningitis Encephalitis Panel (MEP) multiplex polymerase chain reaction testing of cerebrospinal fluid (CSF) in children with suspected central nervous system infection, as well as the clinical and financial implications.
At Children’s Hospital, pre-post quasi-experimental cohort research was carried out to examine the impact of adopting MEP utilizing a quick CSF diagnostic stewardship program (CHCO). MEP was integrated with electronic medical record indication selection to direct testing to children who met authorized usage criteria: newborns under 2 months old, immunocompromised, encephalitis, and ≥5 white blood cells/μL of CSF. Positive outcomes were provided through real-time antimicrobial stewardship decision assistance. In addition, all patients with CSF acquired through the lumbar puncture and transferred to the CHCO microbiology laboratory that met any of the four criteria mentioned above were included as pre-implementation controls and compared to postimplementation cases. The primary result was the time to optimum antimicrobials measured by the log-rank test and Kaplan–Meier analysis.
The time to optimum antimicrobials fell from 28 hours in 1,124 pre-implementation controls to 18 hours in 1,127 postimplementation cases (P<.0001) (72% with MEP testing conducted). Time to positive CSF findings was faster (4.8 vs. 9.6 hours, P=.0001) after adoption, IV antibiotic duration was shorter (24 vs. 36 hours, P=.004), and infectious neurologic illnesses were more commonly diagnosed (15% vs. 10%, P=.03). There were no changes in the time it took for antimicrobials to become effective, hospital admissions, antimicrobial initiation, or duration of stay. Microbiologic testing prices rose while overall hospital expenditures remained constant.
Implementing MEP in conjunction with a quick central nervous system diagnostic stewardship program reduced antimicrobial usage with faster results, reducing the need for empiric treatment. In addition, routine MEP testing for high-yield indications allows for antimicrobial optimization while maintaining total costs constant.