Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections.

Dustin Carr,Carley Buchanan,Derek N. Bremmer,Thomas L. Walsh,Rawiya Elrufay,Nathan R. Shively,Matthew A. Moffa

doi:10.3390/antibiotics9060282

Abstract

Patients admitted from the community with a suspected central nervous system (CNS) infection require prompt diagnostic evaluation and correct antimicrobial treatment. A retrospective, multicenter, pre/post intervention study was performed to evaluate the impact that the BioFire® FilmArray® meningitis/encephalitis (ME) panel run in-house had on the clinical management of adult patients admitted from the community with a lumbar puncture (LP) performed for a suspected CNS infection. The primary outcome was the effect that this intervention had on herpes simplex virus (HSV) polymerase chain reaction (PCR) turnaround time (TAT). Secondary outcomes included the effect that this intervention had on antiviral days of therapy (DOT), total antimicrobial DOT, and hospital length of stay (LOS). A total of 81 and 79 patients were included in the pre-intervention and post-intervention cohorts, respectively. The median HSV PCR TAT was significantly longer in the pre-intervention group (85 vs. 4.1 h, p < 0.001). Total antiviral DOT was significantly greater in the pre-intervention group (3 vs. 1, p < 0.001), as was total antimicrobial DOT (7 vs. 5, p < 0.001). Pre-intervention hospital LOS was also significantly longer (6.6 vs. 4.4 days, p = 0.02). Implementing the ME panel in-house for adults undergoing an LP for a suspected community-onset CNS infection significantly reduced the HSV PCR TAT, antiviral DOT, total antimicrobial DOT, and hospital LOS.

Highlights

Central nervous system (CNS) infections, such as meningitis and encephalitis, are infectious disease emergencies
The vast majority of patients that undergo an lumbar puncture (LP) for a suspected central nervous system (CNS) infection are exposed to excess antimicrobials that can lead to unintended consequences such as antimicrobial drug resistance and Clostridioides difficile infection (CDI) [4,5]
The objective of this study was to evaluate the impact this rapid diagnostic assay had on patient care, including herpes simplex virus (HSV) polymerase chain reaction (PCR) turnaround time (TAT), antimicrobial days of therapy (DOT), and hospital length of stay (LOS)

Summary

Introduction

Central nervous system (CNS) infections, such as meningitis and encephalitis, are infectious disease emergencies. Patients suspected of having a CNS infection require urgent diagnostic evaluation with a lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis, along with prompt antimicrobial therapy. Patients that undergo CSF analyses remain on broad antimicrobial coverage while waiting days for diagnostic results [2]. This delay can result in preventable harm from unnecessary drug exposure, as well as prolonged hospital stays. The vast majority of patients that undergo an LP for a suspected CNS infection are exposed to excess antimicrobials that can lead to unintended consequences such as antimicrobial drug resistance and Clostridioides difficile infection (CDI) [4,5]. Each additional day spent in a hospital increases the risk of developing a hospital-acquired infection and represents extra cost to the healthcare system [6]

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