Abstract
Rapid molecular diagnostic assays are increasingly used to guide effective antimicrobial therapy. Data on their effectiveness to decrease antimicrobial use in children have been limited and varied. We aimed to assess the impact of the implementation of the FilmArray Meningitis Encephalitis Panel (MEP) on antimicrobial use and outcomes in children. In an observational retrospective study performed at Atlantic Health System (NJ), we sought to evaluate the duration of intravenous antibiotic treatment (days of therapy (DoT)) for patients <21 years of age hospitalized and evaluated for presumptive meningitis or encephalitis before and after the introduction of the MEP. A secondary analysis was performed to determine if recovery of a respiratory pathogen influenced DoT. The median duration of antibiotic therapy prior to the implementation of the MEP was 5 DoT (interquartile range (IQR): 3–6) versus 3 DoT (IQR: 1–5) (p < 0.001) when MEP was performed. The impact was greatest on intravenous third-generation cephalosporin and ampicillin use. We found a reduction in the number of inpatient days associated with the MEP. In the regression analysis, a positive respiratory pathogen panel (RPP) was not a significant predictor of DoT (p = 0.08). Furthermore, we found no significant difference between DoT among patients with negative and positive RPP (p = 0.12). Our study supports the implementation of rapid diagnostics to decrease the utilization of antibiotic therapy among pediatric patients admitted with concerns related to meningitis or encephalitis.
Highlights
With the aid of rapid molecular diagnostics and the introduction of effective vaccines againstHaemophilus influenzae type b, Streptococcus pneumoniae, and most recently Neisseria meningitides, the epidemiology of meningitis and encephalitis remains a rapidly evolving field [1]
More recent data show that the global incidence of meningitis increased from 2.5 million cases in 1990 to 2.82 million cases in 2016, with the highest rates found in sub-Saharan African countries, known as the meningitis belt [4]
Two-hundred and forty-seven children with suspected meningitis or encephalitis who received empiric antimicrobial therapy were included in the study analysis
Summary
Haemophilus influenzae type b, Streptococcus pneumoniae, and most recently Neisseria meningitides, the epidemiology of meningitis and encephalitis remains a rapidly evolving field [1]. The impact of vaccines has mainly affected children in developed countries, with an over 60% reduction in the incidence of bacterial meningitis in this patient population [2]. Kwambana-Adams et al published the prevalence of bacterial, viral and parasitic infection in children younger than 5 years of age in West Africa following the rollout of conjugate vaccines against pneumococcus (PVC), meningococcus (MenAfriVac) and Haemophilus influenzae [5]. Escherichia coli (4.8%), followed by S. pneumoniae (3.5%) and Plasmodium (3.5%), were the most prevalent etiologies of meningitis in this age group.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
