Impact of a Rapid Diagnostic Meningitis/Encephalitis Panel on Antimicrobial Use and Clinical Outcomes in Children

Abstract

Rapid molecular diagnostic assays are increasingly used to guide effective antimicrobial therapy. Data on their effectiveness to decrease antimicrobial use in children have been limited and varied. We aimed to assess the impact of the implementation of the FilmArray Meningitis Encephalitis Panel (MEP) on antimicrobial use and outcomes in children. In an observational retrospective study performed at Atlantic Health System (NJ), we sought to evaluate the duration of intravenous antibiotic treatment (days of therapy (DoT)) for patients <21 years of age hospitalized and evaluated for presumptive meningitis or encephalitis before and after the introduction of the MEP. A secondary analysis was performed to determine if recovery of a respiratory pathogen influenced DoT. The median duration of antibiotic therapy prior to the implementation of the MEP was 5 DoT (interquartile range (IQR): 3–6) versus 3 DoT (IQR: 1–5) (p < 0.001) when MEP was performed. The impact was greatest on intravenous third-generation cephalosporin and ampicillin use. We found a reduction in the number of inpatient days associated with the MEP. In the regression analysis, a positive respiratory pathogen panel (RPP) was not a significant predictor of DoT (p = 0.08). Furthermore, we found no significant difference between DoT among patients with negative and positive RPP (p = 0.12). Our study supports the implementation of rapid diagnostics to decrease the utilization of antibiotic therapy among pediatric patients admitted with concerns related to meningitis or encephalitis.

Assessment of the Impact of a Meningitis/Encephalitis Panel on Hospital Length of Stay: A Systematic Review and Meta-Analysis

“…While all studies reported the impact of the multiplex ME panel on hospital length of stay, two studies were excluded from the meta-analyses as they did not report enough information to calculate the mean reduction in hospital length of stay [ 15 , 16 ]. Overall, eleven studies reported at least one outcome of interest for inclusion in the meta-analysis [ 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

“…The publication dates ranged from 2018−2021, and where reported, the data included ranged from January 2010 to April 2019 ( Table 1 ). Study designs varied widely, including retrospective cohort [ 15 , 20 , 22 , 23 ], case-control [ 18 , 19 , 21 ], pre/post (or before/after) interventions [ 24 , 25 , 26 ], cross-sectionals studies [ 15 ], combination designs [ 16 ], and randomized controlled trials [ 25 ]. Observational studies overall were of moderate quality while the single RCT in this review had a high risk of bias ( Supplementary Tables S4 and S5 ).…”

“…Settings of care varied, though all studies were performed with hospitalized inpatients. Six papers included patients treated in the intensive care unit (ICU) as well as general inpatient populations [ 18 , 19 , 20 , 22 , 23 , 27 ], two papers included patients treated in the neonate and pediatric intensive care unit (N/PICU) [ 15 , 21 ], and one paper included patients treated in the emergency department (ED) [ 14 ].…”

“…Five papers [ 16 , 21 , 22 , 25 , 27 ] reported exclusively on pediatric patients (i.e., under 18 or 21 years old), seven [ 14 , 17 , 18 , 19 , 22 , 23 , 27 ] reported on adults or patients of mixed ages, and one paper [ 16 ] did not report the age of their included patients. With the exception of five papers [ 15 , 17 , 18 , 25 , 26 ], the majority reported peripheral and/or cerebrospinal white blood cell (WBC) counts and CSF laboratory tests.…”

“…The stratification by age showed that among the four studies [ 19 , 20 , 21 , 24 , 25 ] which included pediatric patients exclusively, there was a nonsignificant reduction in the average length of hospital stay (MD [95% CI]: −1.09 [−2.23, 0.05]; Supplementary Figure S1 ). Among the seven studies including mixed/adult populations [ 14 , 17 , 18 , 19 , 22 , 23 , 27 ], there was a significant association between the multiplex ME panel and reduced length of hospital stay (MD [95% CI]: −1.33 [−2.40, −0.26]).…”