Evaluation of cerebrospinal fluid white blood cell count criteria for use of the BioFire® FilmArray® Meningitis/Encephalitis Panel in immunocompromised and nonimmunocompromised patients

McCreery, Randy; Nielsen, Lindsey; Clarey, Dillon; Murphy, Caitlin N.; Schooneveld, Trevor Van

doi:10.1016/j.diagmicrobio.2021.115605

Cited by 3 publications

(5 citation statements)

References 19 publications

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“…In these studies, the authors showed a safe reduction in herpes virus testing using a cutoff of 10 × 10 6 CSF leukocytes pro liter in non-immunocompromised patients ( 23 , 25 ). Similarly, McCreery et al showed an effective and safe reduction of the ME panel use in non-immunocompromised adults with CSF leukocytes count <10 ×10 6 /l ( 24 ). Due to the reported ( 26 ) possibility of bacterial meningitis with normal cerebrospinal fluid leukocytes counts and presence of severely immunocompromised patients in our analysis, protein concentration in cerebrospinal fluid was included in our criteria.…”

Section: Discussionmentioning

confidence: 97%

“…These observations warrant a more rational use of this panel to reduce unnecessary tests and costs. Development of management and testing guidelines (21,22) and education of clinicians are essential, but, as described in previous studies (23,24), not sufficient to reach this goal. Therefore, the use of clinical decision support may represent a good option to improve testing behavior, identifying the patient population that may benefit the most from this test and avoiding unnecessary investigations (24).…”

Section: Discussionmentioning

confidence: 99%

“…Development of management and testing guidelines (21,22) and education of clinicians are essential, but, as described in previous studies (23,24), not sufficient to reach this goal. Therefore, the use of clinical decision support may represent a good option to improve testing behavior, identifying the patient population that may benefit the most from this test and avoiding unnecessary investigations (24). In our analysis, we confirmed a widespread, indiscriminate use of the ME panel probably as a consequence of a significant overestimation of an infectious etiology underlying the presentation of the respective patients, which may be identified by the ME panel.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, we developed a simple decision rule based on leukocytes and protein concentration in CSF to promote a rational use of the ME panel and provide clinical decision support in patients with suspected CNS infection. These criteria were based on previous studies using similar strategies to safely reduce the ME panel use or CSF herpes virus testing (23)(24)(25). In these studies, the authors showed a safe reduction in herpes virus testing using a cutoff of 10 × 10 6 CSF leukocytes pro liter in non-immunocompromised patients (23,25).…”

Section: Discussionmentioning

confidence: 99%

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Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule

Erba,

Franzeck,

Hinic

et al. 2024

Front. Med.

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BackgroundThe Biofire® FilmArray® Meningitis/Encephalitis (ME) PCR panel covers 14 viral, bacterial, and fungal pathogens and has been implemented in many institutions worldwide. Post-marketing studies indicate a reduced sensitivity and overutilization underscoring the need for a more targeted usage. The aim of our study is to describe the utilization of the ME panel and to develop a diagnostic-stewardship based decision rule.MaterialsAdult patients, who underwent CSF analysis with the ME panel between August 2016 and June 2021 at the University Hospital Basel, were included. Demographic, clinical, microbiological, and laboratory data were extracted from the electronic health record. Factors associated with a positive ME panel result were identified, and a decision rule was developed to potentially optimize the diagnostic yield and reduce the number of unnecessary tests.Results1,236 adult patients received at least one panel in the observed period, of whom 106 panels tested positive (8.6%). The most frequently observed pathogens were Varicella Zoster Virus (VZV, 27%), Streptococcus pneumoniae (19%), Enterovirus (16%), Herpes simplex Virus 1/2 (16%), and Human Herpesvirus 6 (HHV-6, 13%). Fever, vomiting, headache, and photophobia were more frequently present in test positive patients as were significantly higher CSF leukocytes and protein concentrations. When simulating a decision rule based on CSF leukocytes and protein concentration, only 35% of all patients would have qualified for a ME panel tests, thereby increasing the positivity rate to 22.7%. 10 of 106 positive ME panels would have been missed, only involving HHV-6 and VZV (6 and 4 cases, respectively). As these subjects were either severely immunocompromised or had clinical features of shingles we propose extending the testing algorithm by including those criteria.ConclusionThe ME panel positivity rate at our institution was similar as previously published. Our results highlight the need for diagnostic-stewardship interventions when utilizing this assay by implementing a stepwise approach based on a limited number of clinical and laboratory features. This decision rule may improve the pretest probability of a positive test result, increase the quality of test utilization, and reduce costs.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule

Erba,

Franzeck,

Hinic

et al. 2024

Front. Med.

View full text Add to dashboard Cite

show abstract

“…Studies with such a pre-selection (e.g., positive gram stain, detection of leukocytes and/ or bacteria, urgent clinical suspicion) show relatively high detection rates of pathogens in comparison to other studies [20]. Use of the array in patients with no suspicion for a CNS infection or in samples with normal CSF cell count could be avoided [21,22]. Exceptions might be CSF samples from patients with suspected sterile acute bacterial meningitis (in such cases, the CSF/serum glucose ratio is usually low) or patients with suspected early HSV encephalitis (as studies showed that 20% of patients with HSV encephalitis present with an initially normocytic CSF [23]).…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid analysis in emergency patients with suspected infection of the central nervous system

Völk

Dobler

Koedel

et al. 2022

Euro J of Neurology

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Background and purpose Meningitis and encephalitis are potentially life‐threatening diseases that require fast and accurate diagnostics and therapy. The value of polymerase chain reaction (PCR) multiplex testing in clinical practice is still a matter of debate. This study aims to evaluate its benefits and limitations in emergency patients. Methods We assessed the value of a meningoencephalitis PCR array in the clinical routine of an emergency department. Results Of 1578 emergency patients who received a lumbar puncture, 43% received it for a clinically suspected central nervous system (CNS) infection. After initial workup for cerebrospinal fluid (CSF) cell count, protein and glucose, a CNS infection was still considered likely in 307 patients. In these patients, further microbiologic workup was performed. A total of 230 samples were examined by PCR and a pathogen was detected in 66 of these samples. In the case of a positive microbiologic result, a comparison between PCR array and standard method was available for 59 samples, which demonstrated an overcall agreement of 80% (n = 47/59). Of interest, exclusively array‐positive results were observed for patients with meningitis found to be positive for Streptococcus pneumoniae; four out of five patients had been treated with antibiotics before the lumbar puncture. In samples with normal CSF cell count only two positive array results were obtained, both for human herpesvirus 6, and these were not clinically relevant. Conclusion Our data suggest that the array substantially contributes to a detection of pathogens in patients with suspected CNS infection and seems of particular interest in patients with acute bacterial meningitis under empiric antibiotic treatment. In CSF samples with normal cell count, it might be dispensable.

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Diagnostic Stewardship in Clinical Microbiology

Chew,

Chia,

Vasoo

2023

ClinMicroNow

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Patient evaluation begins with a thorough symptom review and history, followed by physical examination to develop differential diagnoses for the patient's clinical presentation. Diagnostic testing is subsequently requested to confirm or exclude specific diagnoses. Diagnostic stewardship may be defined as performing the right test for the right patient for the right reasons at the right time, with the right interpretation which results in the right treatment, optimizing patient care. The postanalytical phase involves final reporting and interpretation of results, as well as the clinician's application of the results to guide patient management. Underutilization of blood cultures can lead to missed diagnoses and delayed or inappropriate therapy. Diagnosing ventilator‐associated pneumonia is complicated by the frequent colonization of the respiratory tract with Enterobacterales and nonfermenting Gram‐negative bacilli. A diagnostic stewardship program should ensure value and implement evidence‐based practice in clinical microbiology, where attention is paid to both accuracy and optimal patient outcomes.

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Evaluation of cerebrospinal fluid white blood cell count criteria for use of the BioFire® FilmArray® Meningitis/Encephalitis Panel in immunocompromised and nonimmunocompromised patients

Cited by 3 publications

References 19 publications

Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule

Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule

Cerebrospinal fluid analysis in emergency patients with suspected infection of the central nervous system

Diagnostic Stewardship in Clinical Microbiology

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