The Utility of Using FilmArray Meningitis-Encephalitis PCR Panel (MEP) in Children Admitted With Meningitis and Encephalitis: Is It a Useful Stewardship Tool?

Objective

FilmArray Meningitis-Encephalitis Polymerase Chain Reaction (PCR) Panel (MEP) allows for rapid detection or exclusion of pathogens causing meningitis and encephalitis (ME) in neonates and children. Studies showed its high sensitivity and specificity as a tool in diagnosing ME. We conducted a retrospective study in our institution to evaluate MEP usage in our pediatric population, assess the agreement between MEP and cerebrospinal fluid (CSF) culture, and measure the impact of MEP results on discontinuing empiric antimicrobials.

Methods

We reviewed electronic records of patients aged 0 to 18 years admitted with possible ME from January 1, 2019, to April 30, 2023. We excluded patients with ventriculoperitoneal shunt infections, immunocompromised hosts, and patients who did not receive antibiotics.

Results

We included 136 patients admitted with possible ME and treated with antibiotics. Of all patients, 6.6% had viral PCR detected (n = 9), 3.7% had bacterial PCR detected (n = 5), 89.7% had negative PCR (n = 122). There was high agreement between MEP and CSF culture results (Gwet agreement coefficient was 0.9915). The comparison of MEP vs CSF pleocytosis showed a low sensitivity (24%). Empiric vancomycin was started in 41% of patients who had no additional focus of infection on admission (n = 46/111) and was discontinued within 12 hours of MEP results in 46.6% of cases (n = 21/46). Acyclovir was combined with antibiotics empirically in 13.5% of cases only (n = 15/111).

Conclusion

MEP is an important diagnostic stewardship tool. It is highly sensitive and specific in diagnosing ME in children. Agreement with CSF cultures is very high. Using CSF pleocytosis as an indication for MEP testing has a low yield.