Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study

Alexandra Hagen,Anna Eichinger,Johannes Huebner,Tilmann Schober,Melanie Meyer-Buehn

doi:10.1186/s12887-020-1944-2

Alexandra Hagen, Anna Eichinger + Show 3 more

Open Access

https://doi.org/10.1186/s12887-020-1944-2

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Journal: BMC Pediatrics	Publication Date: Feb 5, 2020
Citations: 27	License type: open-access

Affiliation: Ludwig-Maximilians-Universität München

Abstract

BackgroundPrompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis. However, in children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. Novel multiplex PCR (mPCR) panels provide rapid on-site diagnostic testing for a variety of pathogens. This study compared empiric antibiotic and acyclovir usage before and after the introduction of an on-site FilmArray Meningitis/Encephalitis Panel (FA ME Panel).MethodsWe retrospectively compared data for empiric antibiotic and acyclovir usage between pediatric patients with suspected central nervous system (CNS) infection receiving mPCR testing and a matched historical control group. Patients were matched by age and suspected CNS infection. We included all patients for whom empiric antibiotics and/or acyclovir were prescribed.ResultsEach study group consisted of 46 patients with 29 (63.0%) infants and 17 (37.0%) older children. A viral pathogen was diagnosed in 5/46 (10.9%) patients in the control group (all enteroviruses) and in 14/46 (30.4%) patients in the mPCR group (enterovirus n = 9; human herpesvirus 6 (HHV-6) n = 5), (p = 0.038)). Length of Therapy (LoT) and Days of Therapy (DoT) for antibiotics were significantly lower for infants (4.0 vs. 3.0, p = 0.038 and 8.0 vs. 6.0, p = 0.015, respectively). Acyclovir therapy was significantly shorter for both, infants and older children (3.0 vs. 1.0 day, p < 0.001 for both age groups).ConclusionThe findings of our study suggest that the introduction of a FA ME Panel into clinical routine procedures is associated with a significantly reduced LoT and DoT of empiric anti-infective treatment in children with suspected meningoencephalitis. The largest effect was observed in infants.

Highlights

Prompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis
We identified all patients below 18 years with suspected central nervous system (CNS) infection who underwent multiplex PCR (mPCR) testing during the study period, and for whom empiric antibiotics and/or acyclovir was prescribed
One patient in the mPCR group was admitted to the hospital twice due to suspected meningoencephalitis

Summary

Introduction

Prompt initiation of empiric therapy is common practice in case of suspected meningitis or encephalitis. In children the most common pathogens are viruses that usually do not require and are not covered by the applied anti-infective treatment. In case of bacterial or herpes simplex virus (HSV) infection, early initiation of antibiotics or acyclovir is essential and associated with better outcomes [1,2,3,4]. In febrile infants undergoing evaluation for meningoencephalitis, the most common infectious agents found are viruses other than HSV, which usually cause self-limiting diseases, do not require anti-infective therapy and are not affected by the treatment with antibiotics and/ or acyclovir [5]. Early initiation of anti-infective therapy is common practice, [8, 9] resulting in unnecessary usage of antimicrobials. Antibiotic-associated changes in the child’s microbiome have been shown to have sometimes long term consequences on the patient’s health [14]

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Conclusion