Impact of the BioFire FilmArray Meningitis-Encephalitis Panel on Management of Suspected Paediatric Central Nervous System Infections: A Single-Centre Retrospective Cohort Study.

BACKGROUND

Meningoencephalitis causes significant morbidity and mortality in children worldwide. Prompt diagnosis remains challenging, yet advances in molecular diagnostic technology have improved diagnostic performance. This study examined whether the introduction of the BioFire FilmArray meningitis/encephalitis (ME) multiplex panel impacted the diagnosis and management of children with suspected meningoencephalitis.

METHODS

We conducted a retrospective cohort study (January 2019 to July 2021) at a non-tertiary hospital in Sydney, Australia, during which the BioFire ME panel became available. Patients < 16 years who had cerebrospinal fluid (CSF) sampling for investigation of meningoencephalitis were included. Demographic, clinical and microbiological data were extracted to evaluate time to infection diagnosis, antimicrobial rationalisation and duration, investigations undertaken and admission length.

RESULTS

There were 122 CSF samples collected from children with suspected meningoencephalitis; 70/122 (57.3%) before and 52/122 (42.7%) after BioFire ME panel introduction. Twenty-eight (23.0%) children had BioFire ME testing. Seven bacterial and 27 viral microbiologically confirmed central nervous system (CNS) infections were identified. BioFire ME panel use was associated with faster median confirmation or exclusion of meningoencephalitis (12.6 vs. 48.0 h, p < 0.01, for bacterial and 12.6 vs. 71.5 h, p < 0.01, for viral causes), quicker pathogen identification in viral meningoencephalitis (8.1 vs. 48.7 h, p = 0.019) and earlier antimicrobial rationalisation (24.0 vs. 30.4 h, p < 0.01). Total antimicrobial duration, investigation numbers and hospitalisation duration were not reduced.

CONCLUSIONS

The BioFire ME panel has the potential to reduce the duration of empiric broad-spectrum antimicrobials and their associated adverse effects on children, as well as improve healthcare resource efficiencies.