1398. Clinical Performance of Film Array Meningitis/Encephalitis Multiplex PCR Panel in CNS Infection

Abstract

BackgroundRapid identification of pathogen is important in the management of meningoencephalitis. A fully-automated multiplex PCR, the FilmArray (FA) meningitis/encephalitis (ME) panel, detects 14 pathogens simultaneously in an hour. As there is not much data on this, we undertook this study to understand its performance.MethodsA retrospective analysis was done on patients, both adult and pediatric, admitted with meningitis/encephalitis syndrome between December 2016 and 2018 and who underwent the FA–ME panel (BioFire Diagnostics, USA) multiplex PCR test on CSF. The performance of the FA- ME panel was compared with that of routine tests done on CSF which is cell count, biochemistry, gram stain, bacterial culture, and other relevant tests.ResultsFA- ME panel was done in 259 patients and it detected pathogen in 61 (23.6%) patients with ME syndrome. Viruses accounted for 70.4%, bacteria 24.5%, and 2 patients had 2 organisms in a single sample (enterovirus and H. influenzae on both occasions). Enterovirus was the commonest accounting for 29 cases, followed by varicella in 11, pneumococci in 9. HHV 6, H. influenzae, Strep agalactiae and Listeria were the rest. Enterovirus meningitis showed seasonal prevalence; 24 out of 29 cases occurred during October till December. CSF bacterial culture yield was low, positive only in 8 (3%) cases and matched with FA ME panel in one sample which grew pneumococci; 7 other cultures grew either Gram-negative pathogens, rare organisms/ contaminants not included in FA ME panel. CNS tuberculosis was diagnosed in 6, 7 patients had aseptic meningitis due to tropical infections, 5 of which were dengue fever, 2 were scrub typhus. Overall, 191 patients (73.7%) were treated as CNS infection through FA ME panel were negative in 130 of these, rest had alternative diagnosis. Antibiotic de-escalation was better in the group with positive FA ME panel result.ConclusionFA-ME panel has better diagnostic yield compared with culture (26.3% vs. 3%). Viruses were commoner and majority were enteroviruses showing seasonal prevalence. Those bacteria that grew in CSF culture but not identified by FA ME panel were Gram-negative or unusual pathogens. Additional tests need to be used when considering post-traumatic or nosocomial meningitis, tuberculosis, and tropical infections. Disclosures All authors: No reported disclosures.