Impact of the Film Array Meningitis/Encephalitis panel in adults with meningitis and encephalitis in Colombia.

Karen Melissa Ordóñez Díaz,Rodrigo Hasbun,Laura Marcela Barón,Oscar Felipe Suárez Brochero,John Alexander Alzate Piedrahíta,Daniel Orozco Granada,Isabella Cortés Bonilla

doi:10.1017/s0950268820001648

Abstract

The Biofire® Film Array Meningitis Encephalitis (FAME) panel can rapidly diagnose common aetiologies but its impact in Colombia is unknown. A retrospective study of adults with CNS infections in one tertiary hospital in Colombia. The cohort was divided into two time periods: before and after the implementation of the Biofire® FAME panel in May 2016. A total of 98 patients were enrolled, 52 and 46 were enrolled in the Standard of Care (SOC) group and in the FAME group, respectively. The most common comorbidity was human immunodeficiency virus infection (47.4%). The median time to a change in therapy was significantly shorter in the FAME group than in the SOC group (3 vs. 137.3 h, P < 0.001). This difference was driven by the timing to appropriate therapy (2.1 vs. 195 h, P < 0.001) by identifying viral aetiologies. Overall outcomes and length of stay were no different between both groups (P > 0.2). The FAME panel detected six aetiologies that had negative cultures but missed identifying one patient with Cryptococcus neoformans. The introduction of the Biofire FAME panel in Colombia has facilitated the identification of viral pathogens and has significantly reduced the time to the adjustment of empirical antimicrobial therapy.

Highlights

Meningitis and encephalitis continue to be associated with significant neurological morbidity and mortality [1], so establishing a cause and administering prompt antimicrobial therapy is crucial in improving clinical outcomes in several aetiologies [2, 3]
In patients with bacterial meningitis, the sensitivity of the cerebrospinal fluid (CSF) Gram stain ranges from 10% to 93% and the CSF cultures between 50% and 85% depending on the pathogen, country of the study and by the receipt of previous antibiotic therapy [5]
Data were collected through an electronic format which include demographic variables, clinical, paraclinical (CSF cytochemical), culture results, Film Array Meningitis Encephalitis (FAME) panel test result, days of antimicrobial treatment, difference in hours to make adjustments to the antimicrobial with microbiological test results, days were evaluated of total hospitalisation, days of hospitalisation in ICU, state of discharge

Summary

Introduction

Meningitis and encephalitis continue to be associated with significant neurological morbidity and mortality [1], so establishing a cause and administering prompt antimicrobial therapy is crucial in improving clinical outcomes in several aetiologies [2, 3]. In patients with bacterial meningitis, the sensitivity of the CSF Gram stain ranges from 10% to 93% and the CSF cultures between 50% and 85% depending on the pathogen, country of the study and by the receipt of previous antibiotic therapy [5]. This diagnostic uncertainty and the fear of an adverse outcome lead to an indiscriminate use of antimicrobials in the majority of patients. Clinicians prefer to initiate and maintain broad-spectrum therapies that include antibiotics, antivirals and in the case of HIV-positive antifungal patients, which increases treatment costs and the risk of adverse events such as nephrotoxicity and Clostridium difficile diarrhoea [6]

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