Impact of the implementation of a rapid meningitis/encephalitis multiplex polymerase chain reaction panel on IV acyclovir duration: multicenter, retrospective cohort of adult and pediatric patients

Evans, Martha; Merkel, Kathryn; Harder, Jenny; Rose, Dusten T.

doi:10.1016/j.diagmicrobio.2019.114935

Cited by 19 publications

(29 citation statements)

References 16 publications

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“…While a patient admitted from the community with a suspected CNS infection represents a medical emergency, it is common not to find a pathogen causing a treatable infection in the majority of patients, similar to our findings [3,9,10]. A rapid, multiplex PCR not only provides clinicians with the ability to quickly adjust therapy to target a pathogen, but also provides the ability to rapidly discontinue unnecessary antimicrobials.…”

Section: Discussionsupporting

confidence: 81%

“…This is one of the first studies to evaluate the clinical impact of an in-house multiplex PCR assay on the care of adult patients admitted from the community with a suspected CNS infection. Similar to prior studies, we found a significantly reduced diagnostic TAT and a reduction in antiviral therapy [2,7,9,10,14]. Additionally, our study included a diverse patient population by incorporating both a quaternary academic referral center as well as a community-based teaching hospital.…”

Section: Discussionsupporting

confidence: 78%

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Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

et al. 2020

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Patients admitted from the community with a suspected central nervous system (CNS) infection require prompt diagnostic evaluation and correct antimicrobial treatment. A retrospective, multicenter, pre/post intervention study was performed to evaluate the impact that the BioFire® FilmArray® meningitis/encephalitis (ME) panel run in-house had on the clinical management of adult patients admitted from the community with a lumbar puncture (LP) performed for a suspected CNS infection. The primary outcome was the effect that this intervention had on herpes simplex virus (HSV) polymerase chain reaction (PCR) turnaround time (TAT). Secondary outcomes included the effect that this intervention had on antiviral days of therapy (DOT), total antimicrobial DOT, and hospital length of stay (LOS). A total of 81 and 79 patients were included in the pre-intervention and post-intervention cohorts, respectively. The median HSV PCR TAT was significantly longer in the pre-intervention group (85 vs. 4.1 h, p < 0.001). Total antiviral DOT was significantly greater in the pre-intervention group (3 vs. 1, p < 0.001), as was total antimicrobial DOT (7 vs. 5, p < 0.001). Pre-intervention hospital LOS was also significantly longer (6.6 vs. 4.4 days, p = 0.02). Implementing the ME panel in-house for adults undergoing an LP for a suspected community-onset CNS infection significantly reduced the HSV PCR TAT, antiviral DOT, total antimicrobial DOT, and hospital LOS.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 78%

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

et al. 2020

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“…Reversetranscription PCR (RT-PCR) to detect the viral nucleic acid in the CSF of PVM patients revealed a 100% sensitivity rate and proved far superior to the virus isolation technique in both EVsand HPeV-positives cases of PVM (23,24). Multiplex PCR is now frequently used in clinical and epidemiological investigations to identify the causative virus in PVM patients (162,(186)(187)(188). Additionally, approval of some molecular diagnostic kits, such as FilmArray R BioFire R Meningitis/Encephalitis (ME) panel, have significantly reduced the time for detection of the viral etiology of PVM (188,189).…”

Section: Diagnostic Challengesmentioning

confidence: 99%

“…Multiplex PCR is now frequently used in clinical and epidemiological investigations to identify the causative virus in PVM patients (162,(186)(187)(188). Additionally, approval of some molecular diagnostic kits, such as FilmArray R BioFire R Meningitis/Encephalitis (ME) panel, have significantly reduced the time for detection of the viral etiology of PVM (188,189). A particular point of concern for the use of PCR during EVs-caused PVM was raised, which indicated that the test is superior to serology as it is significantly helpful for the diagnosticians to differentiate between the various serotypes of EVs causing the disease (76).…”

Section: Diagnostic Challengesmentioning

confidence: 99%

Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review

et al. 2022

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Meningitis is an inflammation of the brain and spinal cord meninges caused by infectious and non-infectious agents. Infectious agents causing meningitis include viruses, bacteria, and fungi. Viral meningitis (VM), also termed aseptic meningitis, is caused by some viruses, such as enteroviruses (EVs), herpesviruses, influenza viruses, and arboviruses. However, EVs represent the primary cause of VM. The clinical symptoms of this neurological disorder may rapidly be observed after the onset of the disease, or take prolonged time to develop. The primary clinical manifestations of VM include common flu-like symptoms of headache, photophobia, fever, nuchal rigidity, myalgia, and fatigue. The severity of these symptoms depends on the patient's age; they are more severe among infants and children. The course of infection of VM varies between asymptomatic, mild, critically ill, and fatal disease. Morbidities and mortalities of VM are dependent on the early recognition and treatment of the disease. There were no significant distinctions in the clinical phenotypes and symptoms between VM and meningitis due to other causative agents. To date, the pathophysiological mechanisms of VM are unclear. In this scientific communication, a descriptive review was performed to give an overview of pediatric viral meningitis (PVM). PVM may occasionally result in severe neurological consequences such as mental retardation and death. Clinical examinations, including Kernig's, Brudzinski's, and nuchal rigidity signs, were attempted to determine the clinical course of PVM with various success rates revealed. Some epidemiological correlates of PVM were adequately reviewed and presented in this report. They were seen depending mainly on the causative virus. The abnormal cytological and biochemical features of PVM were also discussed and showed potentials to distinguish PVM from pediatric bacterial meningitis (PBM). The pathological, developmental, behavioral, and neuropsychological complications of PVM were also presented. All the previously utilized techniques for the etiological diagnosis of PVM which include virology, serology, biochemistry, and radiology, were presented and discussed to determine their efficiencies and limitations. Finally, molecular testing, mainly PCR, was introduced and showed 100% sensitivity rates.

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“…These panels testing for multiple pathogens with a single test have improved diagnostic yield compared to the standard of care where one to many individual tests are ordered. As an example, a multiplex PCR for meningitis/encephalitis has demonstrated improved diagnostic yield in several studies with a reduction in length of stay and improved therapy (i.e., discontinuation of empiric antimicrobials where appropriate) also demonstrated [ 12 , 13 , 14 , 15 , 16 ]. Similarly, for neurological infections without a diagnosis due to uncommon pathogens not identified by routine methods, metagenomic next-generation sequencing (NGS) has shown promise in identifying rare etiologies [ 17 ].…”

Section: Considerations For Pre-analytical Diagnostic Stewardship Int...mentioning

confidence: 99%

Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement

2022

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Diagnostic stewardship aims to deliver the right test to the right patient at the right time and is optimally combined with antimicrobial stewardship to allow for the right interpretation to translate into the right antimicrobial at the right time. Laboratorians, physicians, pharmacists, and other healthcare providers have an opportunity to improve the effectiveness of diagnostics through collaborative activities around pre-analytical and post-analytical periods of diagnostic testing. Additionally, special considerations should be given to measuring the effectiveness of diagnostics over time. Herein, we perform a narrative review of the literature on these potential optimization opportunities and the temporal factors that can yield changes in diagnostic effectiveness. Our objective is to inform on these considerations to ensure enhanced value through improved implementation and measurement of effectiveness for local stakeholder metrics and/or clinical outcomes research.

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Impact of the implementation of a rapid meningitis/encephalitis multiplex polymerase chain reaction panel on IV acyclovir duration: multicenter, retrospective cohort of adult and pediatric patients

Cited by 19 publications

References 16 publications

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review

Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement

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