338. The Use of Multiplex PCR Panel in the Diagnosis of Meningitis in Children

Abstract

BackgroundCerebrospinal fluid (CSF) culture remains the gold standard for the diagnosis of bacterial meningitis, with viral PCR considered when clinically indicated. These tests can take 48–72 hours to result, during which patients receive empiric antimicrobial therapy and remain hospitalized. BioFire FilmArray™ Meningitis/Encephalitis panel (MEP) tests CSF for 14 bacterial, viral, and fungal pathogens with turnaround time of 1 hour. The objective of the study was to compare the results of the MEP to that of bacterial cultures, to evaluate the potential impact on length of stay (LOS) and antimicrobial use in our pediatric population.MethodsA retrospective review of data from MEP processed by Health Network Laboratories in children ≤18 years of age, from February 1, 2016 to December 31, 2017, at Lehigh Valley Children’s Hospital.ResultsA total of 220 MEP results were included in the study, with 46 positive samples. Of the positive samples, five were positive for bacterial organisms, four E. coli and 1 N. meningitidis. Four of the corresponding CSF cultures grew E. coli. The CSF culture corresponding to the MEP positive for N. meninigitidis, was negative, but both samples were collected after one dose of ceftriaxone. Of the positive MEPs, 89% were positive for a viral pathogen, with threesamples positive for Herpes Simplex Virus (HSV). MEPs had a lower average turnaround time of 6.9 hours when compared with CSF cultures of 48.8 hours. Average LOS was 5.7 days for those with a negative MEP compared with 3.8 days for those with a positive viral MEP other than HSV. Empiric antiviral treatment with acyclovir was initiated in 58 patients; patients with a negative MEP for HSV received an average of 3.13 doses.ConclusionThe study showed 100% concordance between MEP and CSF culture for E. coli meningitis. The discordance between CSF culture and MEP corresponding to N. meningitidis indicates that the increased sensitivity of MEP may play a role in the management of partially treated meningitis. The use of the BioFire MEP may be helpful in decreasing the average LOS in patients where a viral etiology other than HSV is identified. Faster turnaround time of MEP may decrease the number of antiviral doses in those with a negative MEP for HSV.Disclosures All authors: No reported disclosures.