273. Effects of a Rapid Meningitis/Encephalitis Panel on Antimicrobial Use and Clinical Outcomes in Children

Abstract

BackgroundRapid molecular diagnostic assays are increasingly used to guide effective antimicrobial therapy. Data on their effectiveness to decrease antimicrobial use have been limited and varied. We aimed to assess the impact of the implementation of the FilmArray Meningitis Encephalitis Panel (MEP) on antimicrobial (AM) use and outcomes in children.MethodsIn an observational retrospective study performed at Atlantic Health System (NJ), we reviewed medical records of patients <21 years of age evaluated for meningitis/encephalitis who received empiric AM therapy between January 1, 2015 and September 30, 2018. Oncology and Neurosurgery patients were excluded. FilmArray MEP (BioFire Diagnostics, Salt Lake City, UT) was incorporated November 1, 2016. The primary outcome was to evaluate duration of empiric AM therapy measured as days of therapy (DOT). Secondary outcomes included length of stay (LOS), all-cause mortality, and 30-day readmission rates.ResultsNinety-nine patients with negative CSF, blood, and urine cultures who received empiric AM therapy were included in the preliminary analysis. Patient characteristics are depicted in Table 1. The median duration of antibiotic (AB) therapy prior to the implementation of the MEP was four DOT (IQR 6) vs. two DOT (IQR 4). During the pre-implementation era, the median DOT for individual AB was three (IQR 2) for third-generation cephalosporins (3GCs) (n = 23), three (IQR 1) for ampicillin (AMP) (n = 19), and two (IQR 1) for vancomycin (VAN) (n = 8). Median DOT when MEP was performed was two (IQR 1) for 3GCs (n = 28), two (IQR 1) for AMP (n = 18), and two (IQR 1) for VAN (n = 6). Few patients received acyclovir (ACY), with a median DOT of four (IQR 0) and two (IQR 2) before (n = 4) and after MEP (n = 8), respectively. Secondary outcomes are shown in Table 2.Table 1: Patient CharacteristicsPre-MEP(N = 49)MEP(N = 50)Age in years, mean (range)3.8 (0–18)3.5 (0–17)Male:female1:12:1NICU/PICU care, n (%)11 (23)16 (32)CSF WBC, median (IQR)2 (14) cells/mm33 (10) cells/mm3Table 2.Pre-MEP(N = 49)MEP(N = 50)LOS, median (IQR)4 (3)3 (2)All-cause 30 day-readmission40All-cause mortality00ConclusionIn our experience, the implementation of the MEP decreased AB use and LOS. This impact was noted mainly on 3GCS and AMP. Few patients received VAN and ACY to assess the effect on these agents.Disclosures All authors: No reported disclosures.