Retrospective Evaluation of Infants 1–60 Days Evaluated for Meningitis Using the FilmArray Meningitis/Encephalitis (ME) Panel
Authors: Blaschke Anne J , Holmberg Kristen , Daly Judy , Leber Amy , Bard Jennifer Dien , Bourzac Kevin , Kanack Kristen 
Published: October 2017

Abstract

Background
Bacterial meningitis is a serious infection in infants requiring emergent recognition. Viral encephalitides (excluding HSV) are usually self-limited and care is supportive. Young infants often undergo lumbar puncture to evaluate for infection, but identification of CNS pathogens can take 24–48 hours while they are hospitalized and empirically treated. Our objective was to study the potential effect of a rapid multiplex PCR for meningitis/encephalitis (ME) on the care of young infants.

Methods
A prospective clinical evaluation of the FilmArray ME Panel was conducted from 2/2014 to 9/2014 at 11 sites using residual CSF. FilmArray ME Panel results were compared with clinical reference standards but not shared with providers. In this current study, medical records for infants (1–60 days) enrolled at three sites were reviewed for potential management changes with rapid FilmArray ME Panel results.

Results
A total of 145 infants were reviewed. Median age was 25 days. Most were admitted to the hospital [132/145 (91%)], received antibiotics [123/145 (85%)], and almost half [71/145 (49%)] received acyclovir. Only one infant had a bacterial pathogen identified by PCR, and no infant had CSF positive for HSV. Of the 145 infants (25%) 36 had a viral pathogen detected; 35 (97%) by FilmArray ME Panel and 23 (64%) by conventional tests (2 by blood PCR only). Four (11%) had a concomitant bacterial infection [UTI (3); bacterial meningitis (1; diagnosed on a prior LP)]. Twenty infants (56%) had enterovirus detected and 10 (28%) were positive for human parechovirus. Four infants were positive for HHV-6. 33 infants (92%) with a virus detected from CSF were admitted to the hospital; median duration of hospital stay was 44 hours [IQR: 34–69]. Infants who were virus-positive by conventional testing (results known to the physician) had a median length of hospital stay of 44 hours [IQR: 32–48] while median length of stay was 72 hours [IQR: 41–109] for those that were virus-positive only retrospectively by FilmArray ME Panel.

Conclusion
The FilmArray ME Panel may play a role in the evaluation of young infants undergoing lumbar puncture to evaluate for infection. Results of rapid PCR may be used to guide management, possibly resulting in decreased LOS for infants with viruses other than HSV detected in CSF.

Disclosures
A. J. Blaschke, BioFire Diagnostics, LLC: Collaborator, Grant Investigator and I have intellectual property and receive royalties from BioFire Diagnostics through the University of Utah, Licensing agreement or royalty and Research support; K. Holmberg, BioFire Diagnostics: Employee, Salary; J. Daly, Biofire: Grant Investigator, Grant recipient; A. Leber, BioFIre Diagnostics: Research Contractor and Scientific Advisor, Research support, Speaker honorarium and Travel expenses; J. Dien Bard, BioFire: Consultant and Investigator, Research grant and Speaker honorarium; K. Bourzac, BioFire Diagnostics: Employee, Salary; K. Kanack, BioFire Diagnostics, LLC: Employee, Salary